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Setting benchmark revision rates for total hip replacement : analysis of registry evidence

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Kandala, Ngianga-Bakwin, Connock, M., Pulikottil-Jacob, Ruth, Sutcliffe, P. (Paul), Crowther, Michael, Grove, Amy L., Mistry, Hema and Clarke, Aileen (2015) Setting benchmark revision rates for total hip replacement : analysis of registry evidence. BMJ (Clinical research ed.), 350 . h756. doi:10.1136/bmj.h756

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Official URL: http://dx.doi.org/10.1136/bmj.h756

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Abstract

Objective:

To compare 10 year revision rates for frequently used types of primary total hip replacement to inform setting of a new benchmark rate in England and Wales that will be of international relevance.

Design:
Retrospective cohort study.

Setting:
National Joint Registry.

Participants:
239 000 patient records.

Main outcome measures:
Revision rates for five frequently used types of total hip replacement that differed according to bearing surface and fixation mode, encompassing 62% of all primary total hip replacements in the National Joint Registry for England and Wales. Revision rates were compared using Kaplan-Meier and competing risks analyses, and five and 10 year rates were estimated using well fitting parametric models.

Results:
Estimated revision rates at 10 years were 4% or below for four of the five types of total hip replacement investigated. Rates differed little according to Kaplan-Meier or competing risks analysis, but differences between prosthesis types were more substantial. Cemented prostheses with ceramic-on-polyethylene bearing surfaces had the lowest revision rates (1.88-2.11% at 10 years depending on the method used), and cementless prostheses with ceramic-on-ceramic bearing surfaces had the highest revision rates (3.93-4.33%). Men were more likely to receive revision of total hip replacement than were women, and this difference was statistically significant for four of the five prosthesis types.

Conclusions:
Ten year revision rate estimates were all less than 5%, and in some instances considerably less. The results suggest that the current revision rate benchmark should be at least halved from 10% to less than 5% at 10 years. This has implications for benchmarks internationally.

Item Type: Journal Article
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Total hip replacement
Journal or Publication Title: BMJ (Clinical research ed.)
Publisher: BMJ Group
ISSN: 0959-8138
Official Date: 9 March 2015
Dates:
DateEvent
9 March 2015Published
12 January 2014Accepted
Volume: 350
Article Number: h756
DOI: 10.1136/bmj.h756
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access

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