Documentation of hip prostheses used in NorwayA critical review of the literature from 1996–2000

Abstract

We have conducted a systematic review of the scientific literature concerning outcome and clinical effectiveness of prostheses used for primary total hip replacement (THR) in Norway. The study is based on two Health Technology Assessment reports from the UK (Faulkner et al. 1998, Fitzpatrick et al. 1998), reviewing the literature from 1980 to 1995. Using a similar search strategy, we have evaluated the literature from 1996 through 2000. We included 129 scientific and medical publications which were assessed according to a specific appraisal protocol. The majority (72%) were observational studies, whereas only 9% were randomized studies. We could not retrieve any peer-reviewed documentation for one third of the implants. The Charnley prosthesis had by far the best and most comprehensive evidence base with better than 90% implant survival after about 10 years. Survival of the Charnley prosthesis declines by about 10% during each of the two following decades. Except for the Charnley and Lubinus IP, no other prosthesis on the market in Norway has given long-term results (> 15 years). 5 other cemented implants have given comparable results at about 10 years of follow-up. Some uncemented stems have shown promising medium-term outcome, but no combination of uncemented cup and stem fulfilled the benchmark criterion of > or = 90% implant survival at 10 years, which we propose as a minimum requirement for unrestricted clinical use for prostheses used in primary THR. New or undocumented implants should be introduced through a four-step model including preclinical testing, small series evaluated by radiosterometry, randomized clinical trial involving comparison with a well-documented prosthesis, and finally, surveillance of clinical use through registers.

What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients

“…Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes, such as the radiographic appearance of the prosthesis,4 implant survival5 or surgeon-assessed outcome 6. Nevertheless, many people continue to experience significant pain and functional problems after total joint replacement.…”

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…33 The key issues for surgeons and prosthesis-producing companies were seen to be the design and fixation of a prosthesis that would last for ≥ 10 years, precluding the need for complex revision surgery. 34 However, owing to advances in surgical technique and prosthetics design, joint replacement now has good survivorship and post-surgical complication rates are low.…”

Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: Follow-up of 75 hips for 15–18 years

“…High HHS and lower quality of life assessment points to reasons other than hip disorder. Selfassessment scores have limitations (Aamodt et al 2004) and a broader psychosocial interview might have revealed the difference. This was beyond the scope of our investigation, however.…”