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Significant variability seen among different prosthetic constructs used in primary total hip replacements
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According to recently published results, the performance of different prosthetic constructs significantly varied in patients who underwent primary total hip replacement, and most of the constructs were not found to be noninferior to contemporary benchmarks.
“[The] majority of constructs do not have enough data for meaningful analysis, even though we have now recorded over 1 million hip replacements in the [National Joint Registry for England, Wales, Northern Ireland and the Isle of Man] NJR,” Martyn L. Porter, FRCS, told Healio.com/Orthopedics. “We as a community must accept that it is not justifiable to use so many different constructs without data to support their use. Maybe now is the time for us to concentrate on using fewer implants with proven outcomes. Second, the data shows that for different patient ages and genders and at different time points, implants perform differently, so there is no one-size-fits-all solution for all patients. Surgeons should, however, be able to use the data published here to help make decisions tailored to specific patients.”
Researchers identified patients registered in the NJR who underwent primary THR. The performance of hip prosthetic constructs by brand were compared with the best performing contemporary construct using a noninferiority analysis. A total of 4,442 constructs were used at least once. The 1-Kaplan-Meier survival function was used to estimate construct failure. Investigators tested the difference in failure between the contemporary benchmark and all other constructs used. The Kaplan-Meier failure function for the hip prosthesis was the main outcome measure.
“[It] is apparent that some implants are failing at more than double the rates of others and thus, surgeons need to think carefully as to the reasons for using these implants,” Porter said. “In some cases, their continued use will still be justified by the specific needs and circumstances of the patient.”
Results showed 134 constructs of the 4,442 constructs used had 500 or more patients at risk at 3 years post-primary reconstruction. Investigators noted 89 constructs were not inferior to the benchmark by at least 100% relative risk. There were 26 constructs with 500 or more patients at risk at 10 years post-primary procedure, of which 13 constructs were not inferior to benchmark by at least 20% relative risk.
Porter said, “This work is a useful aid in decision-making. It is not a library of good and bad implants, nor a ranking list of what works best and should not be used as such.”– by Monica Jaramillo
Disclosures: Deere reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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