Comparative assessment of implantable hip devices with different bearing surfaces: Systematic appraisal of evidence

Weill Cornell Medical College, New York, NY 10065, USA.
BMJ (online) (Impact Factor: 17.45). 11/2011; 343(nov29 2):d7434. DOI: 10.1136/bmj.d7434
Source: PubMed


To determine comparative safety and effectiveness of combinations of bearing surfaces of hip implants.
Systematic review of clinical trials, observational studies, and registries.
Medline, Embase, Cochrane Controlled Trials Register, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the United States Food and Drug Administration.
Criteria for inclusion were comparative studies in adults reporting information for various combinations of bearings (such as metal on metal and ceramic on ceramic). Data search, abstraction, and analyses were independently performed and confirmed by at least two authors. Qualitative data syntheses were performed.
There were 3139 patients and 3404 hips enrolled in 18 comparative studies and over 830 000 operations in national registries. The mean age range in the trials was 42-71, and 26-88% were women. Disease specific functional outcomes and general quality of life scores were no different or they favoured patients receiving metal on polyethylene rather than metal on metal in the trials. While one clinical study reported fewer dislocations associated with metal on metal implants, in the three largest national registries there was evidence of higher rates of implant revision associated with metal on metal implants compared with metal on polyethylene. One trial reported fewer revisions with ceramic on ceramic compared with metal on polyethylene implants, but data from national registries did not support this finding.
There is limited evidence regarding comparative effectiveness of various hip implant bearings. Results do not indicate any advantage for metal on metal or ceramic on ceramic implants compared with traditional metal on polyethylene or ceramic on polyethylene bearings.

17 Reads
  • Source
    • "A review of the literature shows a generally increasing interest in the influence of mental disorders in patient's experience of pain (Linton, 2000; Linton, 2005), but in orthopaedic and other departments responsible for surgical procedures, the focus remains centred on physical functions (in relation to indication for surgery) (Okoro et al. 2012; Sedrakyan et al., 2011; Veenhof et al. 2012). A small number of studies, e.g. of hip-operated patients, have shown an association between mental disorder and outcomes of surgery, but further research using a more sensitive and specific questionnaire is still called for (Rolfson et al. 2009; Hossain et al., 2011; Dawson et al., 2001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Common Mental Disorders Questionnaire (CMDQ) is used to assess patients' mental health. It has previously been shown to provide a sensitive and specific instrument for general practitioner setting but has so far not been tested in hospital setting or for changes over time (test-retest). The aim of this study is, by means of a test-retest method, to investigate the reliability of the instrument over time with total hip replacement (THR) patients. Forty-nine hip osteoarthritis patients who had undergone THR answered the questionnaire twelve months after their operation. Fourteen days later they completed it again. Covering emotional disorder, anxiety, depression, concern, somatoform disorder and alcohol abuse, the questionnaire consists of 38 items with six subscales, each of which has between 4 to 12 items. A five-point Likert scale (from 0-4) is used. For each of the 38 questions, a quadratic-weighted Kappa coefficient of 0.42 (0.68 - 0.16) to 0.98 (1.00 - 0.70) was found. A Cronbach's alpha of 0.94 for all the questions indicated high internal consistency. The results showed a moderate to almost perfect reliability of CMDQ of this specific population. Current Controlled Trials: NCT01205295.
    09/2014; 2(1):32. DOI:10.1186/s40359-014-0032-5
  • Source
    • "Recent bearing material improvements have made HRA a viable option once again, particularly in younger and more active patients or those ineligible for THA. Nonetheless, the safety of MoM HRA remains controversial, with complications including femoral neck fractures, component loosening, and metallosis [5] [6] [8] [9]. Despite these concerns and limited evidence regarding revision surgery, the Canadian Joint Replacement Registry reports an increasing trend in the number of MoM HRAs in Canada (o1% of all types of hip replacement in 2003 to 3% in 2007) [10] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Metal-on-metal hip resurfacing arthroplasty (MoM HRA) has emerged as an alternative to total hip arthroplasty (THA) for younger active patients with osteoarthritis (OA). Birmingham hip resurfacing is the most common MoM HRA in Alberta, and is therefore compared with conventional THA. The objective of this study was to estimate the expected cost-utility of MoM HRA versus THA, in younger patients with OA, using a decision analytic model with a 15-year time horizon. A probabilistic Markov decision analytic model was constructed to estimate the expected cost per quality-adjusted life-year (QALY) of MoM HRA versus THA from a health care payer perspective. The base case considered patients with OA aged 50 years; men comprised 65.9% of the cohort. Sensitivity analyses evaluated cohort age, utility values, failure probabilities, and treatment costs. Data were derived from the Hip Improvement Project and the Hip and Knee Replacement Pilot databases in Alberta, the 2010 National Joint Replacement Registry of the Australian Orthopaedic Association, and the literature. In the base case, THA was dominated by MoM HRA (incremental mean costs of -$583 and incremental mean QALYs of 0.079). In subgroup analyses, THA remained dominated when cohort age was 40 years instead of 50 years or when only men were assessed. THA dominated when the cohort age was 60 years or when only women were assessed. Results were sensitive to utilities, surgery costs, and MoM HRA revision and conversion probabilities. At a willingness-to-pay of Can $50,000/QALY, there was a 58% probability that MoM HRA is cost-effective. The results show that, on average, MoM HRA was preferred to THA for younger and male patients, but THA is still a reasonable option if the patient or clinician prefers given the small absolute differences between the options and the confidence ellipses around the cost-effectiveness estimates.
    Value in Health 09/2013; 16(6):942-52. DOI:10.1016/j.jval.2013.06.021 · 3.28 Impact Factor
  • Source

    02/2005; 16:13. DOI:10.14748/bmr.v16.91
Show more

Similar Publications


17 Reads
Available from