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

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journal contribution
posted on 14.05.2019, 10:54 by N-B Kandala, M Connock, R Pulikottil-Jacob, P Sutcliffe, MJ Crowther, A Grove, H Mistry, A Clarke
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.


This project was funded by the Health Technology Assessment programme (project number 11/118). Further information is available at N-BK and AC are also supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands at University Hospitals Birmingham NHS Foundation Trust. AG is supported by the NIHR Doctoral Fellowship Programme (project number DRF-2013-06-064), and MJC is funded by an NIHR doctoral research fellowship (DRF-2012-05-409). This report presents independent research commissioned by the NIHR) to support the work of the National Institute for Health and Care Excellence (NICE).



BMJ, 2015, 350:h756

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences


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Technical appendix, statistical code, and dataset are available from the corresponding author.