Are National Guidelines for Total Hip Replacement in the UK Reflected in Practice?

Abraham, Ann; Hajipour, Leila; Innes, A.R.; Phillips, H. Westley; McCaskie, Andrew W.

doi:10.1308/003588406x82943

Cited by 15 publications

(7 citation statements)

References 12 publications

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“…Over the last 3 decades, the threshold for total hip arthroplasty (THA) has been lowered to include younger and more physically demanding patients ( Abraham et al 2006 , Treacy 2006 ). However, hip arthroplasty surgery in younger patients with more demanding lifestyles has been reported to fail earlier ( Tennent and Goddard 2000 , Lewthwaite et al 2008 , Howcroft et al 2008 ).…”

mentioning

confidence: 99%

“…In order to address this issue, some surgeons have advocated the use of metal-on-metal or ceramic bearing surfaces with cementless porous coated prostheses to reduce implant surface wear rates and bone loss in younger osteoarthritics ( Shetty and Villar 2006 ). Other surgeons have advocated hip resurfacing (HRS) for young patients ( Harty et al 2005 , Abraham et al 2006 , Bengs et al 2008 , Greene et al 2009 ).…”

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confidence: 99%

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The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

Smith¹,

Nichols²,

Donell³

et al. 2010

Acta Orthopaedica

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Background and purposeHip resurfacing (HRS) procedures have gained increasing popularity for younger, higher-demand patients with degenerative hip pathologies. However, with concerns regarding revision rates and possible adverse metal hypersensitivity reactions with metal-on-metal articulations, some authors have questioned the hypothesized superiority of hip resurfacing over total hip arthroplasty (THA). In this meta-analysis, we compared the clinical and radiological outcomes and complication rates of these 2 procedures.MethodsA systematic review was undertaken of all published (Medline, CINAHL, AMED, EMBASE) and unpublished or gray literature research databases up to January 2010. Clinical and radiological outcomes as well as complications of HRS were compared to those of THA using risk ratio, mean difference, and standardized mean difference statistics. Studies were critically appraised using the CASP appraisal tool.Results46 studies were identified from 1,124 citations. These included 3,799 HRSs and 3,282 THAs. On meta-analysis, functional outcomes for subjects following HRS were better than or the same as for subjects with a THA, but there were statistically significantly greater incidences of heterotopic ossification, aseptic loosening, and revision surgery with HRS compared to THA. The evidence base showed a number of methodological inadequacies such as the limited use of power calculations and poor or absent blinding of both patients and assessors, possibly giving rise to assessor bias.InterpretationOn the basis of the current evidence base, HRS may have better functional outcomes than THA, but the increased risks of heterotopic ossification, aseptic loosening, and revision surgery following HRS indicate that THA is superior in terms of implant survival.

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confidence: 99%

mentioning

confidence: 99%

The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

Smith¹,

Nichols²,

Donell³

et al. 2010

Acta Orthopaedica

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“…Exceptionally, one study in Korea showed very poor accordance with published guidelines for antibiotic prophylaxis [25]. Other studies that evaluated guideline adherence for the use of prophylactic antibiotics in THR or TKR procedures in different regions reported adherence rates that ranged from 36.3% to 66.9% [26–30]. In comparison, the guideline adherence rate in Taiwan is relatively low; however, the stable increase in guideline adherence rates after its introduction is a promising phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Practice guideline adherence and health care outcomes – use of prophylactic antibiotics during surgery in Taiwan

Hsu

Cheng

2009

Evaluation Clinical Practice

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“…A survey of members of the British Orthopaedic Association showed widespread use of thromboprophylaxis but no apparent compliance with guidelines. 9 Many readers will recognise from their own practice, from audit of their institution's practice or from discussions with colleagues, that guidelines are not routinely followed.…”

Section: Are Guidelines Followed?mentioning

confidence: 99%

Orthopaedic thromboprophylaxis

Warwick

Dahl

Fisher

2008

The Journal of Bone and Joint Surgery. British volume

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Thromboprophylaxis remains a controversial subject. A vast amount of epidemiological and trial data about venous thromboembolism has been published over the past 40 years. These data have been distilled and synthesised into guidelines designed to help the practitioner translate this extensive research into 'evidence-based' advice. Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive. Guidelines, however, have not been welcomed or applied universally. In the United States, orthopaedic surgeons have published their concerns about the thromboprophylaxis guidelines prepared by the American College of Chest Physicians. In Britain, controversy persists with many surgeons unconvinced of the risk/benefit, cost/benefit or practicality of thromboprophylaxis. The extended remit of the recent National Institute of Clinical Excellence thromboprophylaxis guidelines has been challenged. The reasons for this disquiet are addressed in this paper and particular emphasis is placed on how clinically-acceptable guidelines could be developed and applied.

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Are National Guidelines for Total Hip Replacement in the UK Reflected in Practice?

Cited by 15 publications

References 12 publications

The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

Practice guideline adherence and health care outcomes – use of prophylactic antibiotics during surgery in Taiwan

Orthopaedic thromboprophylaxis

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