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

Ngianga-Bakwin Kandala, Martin Connock, Ruth Pulikottil-Jacob, Michael Crowther, Amy Grove, Aileen Clarke

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40 Citations (Scopus)
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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.
Original languageEnglish
Article numberh756
Number of pages16
JournalBMJ
Volume350
DOIs
Publication statusPublished - 9 Mar 2015

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