How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

Abstract

Summary Background Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? Methods We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). Findings We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0–79·2) and from joint replacement registries was 57·9% (95% CI 57·1–58·7). Interpretation Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. Funding National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.

How might the longer-than-expected lifetimes of hip and knee replacements affect clinical practice?

“…Our studies, in which we report the results for hips and knees in two parallel articles, provide the first generalizable survival estimates for hip and knee replacements at 25 years [7,8]. In each, we conducted a systematic review and meta-analysis of case-series using a single construct reporting survival estimates with mean follow-up of more than 15 years.…”

“…Compared to overall pooled results demonstrating 86% survival at 15 years, we observed survival of 95% in these four constructs (Exeter V40/Trident, Exeter V40/Exeter Contemporary, CPT/Trilogy, and CPT/ZCA). However, these constructs only account for 25% of THRs implanted in England and Wales in 2016 [7]. A recent network meta-analysis concluded that newer THR implant combinations were not superior to a reference implant combination (metal-on-polyethylene, small head, cemented), which may now be considered 'old technology' [12].…”

“…', is important and has a direct impact on patient care. In two recent papers, published in the Lancet, we set out to answer this question [7,8].…”

What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature

“…Total hip arthroplasty (THA) is so successful in restoring mobility and relieving pain in patients with degenerated hip joints [1] that it has been nominated as the operation of the 20th century [2]. Failure, however, remains an issue, with between one-third and nearly half of THA procedures requiring postoperative revision within 30 years [3,4]. One of the possible causes of failure is trunnionosis [5].…”

Multivariate use of MRI biomarkers to classify histologically confirmed necrosis in symptomatic total hip arthroplasty

“…Total hip arthroplasty (THA) is one of the most successful and cost‐effective solutions to address osteoarthritis of the hip. THA has been called “the operation of the century" 1 due to its revolutionary impact on the management of elderly patients crippled with arthritis, and relatively long survivorship of 25 years for about 58% of treated patients 2 . Nevertheless, hip replacements have also multiple failure modes including instability, infection, periprosthetic fracture, and a combination of expected tribological and biological loosening and wear 3,4 .…”