Hip disease - replacement prostheses
Guidance on the Selection of Prostheses for Primary Total Hip Replacement (TA2)
4. Evidence
4.1. The important criteria in the assessment of the clinical effectiveness of a prosthesis are: persistence of pain and immobility, the proportion of THR’s which require revision surgery within a specified period (the revision rate) and the ease with which revision can be carried out.
4.2. The experience of the whole surgical team, including physiotherapists and occupational therapists, contributes to the overall success of THR. In addition various patient factors, including age and underlying pathology, must be taken into account. So, for example, selection of a prosthesis with a long life expectancy will be important for most patients, but ease of revision will be of particular importance for younger patients.
4.3. Specific recommendations on the selection of hip prostheses for primary THR are difficult to construct because the evidence base is generally poor and difficult to interpret, for the following reasons. Few of the studies were of best design to assess clinical effectiveness and few included long term (i.e. more than 10 years) follow-up data. There are often incremental changes in specific prostheses design over time and the interaction between surgeon, hospital team and device performance has not been systematically assessed.
4.4. The available evidence, derived from randomised controlled trials and observational studies (for example hip registers) supports the use of a range of cemented prostheses for primary THR .
4.5. There is currently no cost effectiveness data, based on revision rate of 10 years or more follow up, to support the use of the generally more costly uncemented and hybrid hip prostheses.
4.6. The evidence on immediate and long term postoperative pain supports the use of cemented hip prostheses.
4.7. No reliable evidence was available to support the proposition that the potential ease of revision of a hip prostheses would outweigh its poorer revision rate, notwithstanding any evidence that cementless and hybrid prostheses may lead to less bone loss and are therefore potentially easier to revise than cemented prostheses.
4.8. A list of the source documentation and opinion, which was available to the Appraisal Committee, is set out at Appendix B.
