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

Jonathan T Evans,Jonathan P Evans,Robert W Walker,Ashley W Blom,Michael R Whitehouse,Adrian Sayers

doi:10.1016/s0140-6736(18)31665-9

Jonathan T Evans, Jonathan P Evans + Show 4 more

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https://doi.org/10.1016/s0140-6736(18)31665-9

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Abstract

SummaryBackgroundTotal 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?MethodsWe 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).FindingsWe 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).InterpretationAssuming 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.FundingNational Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.

Highlights

Total hip replacement is one of the most common and effective forms of surgery, resulting in generally ex cellent outcomes.[1]
In the UK, the National Institute of Health and Care Excell ence set a benchmark in 2014, that individual com ponents making up a total hip replacement are only recommended for people with end-stage arthritis, if they have 10-year revision rates of 5% or lower.[2]
We identified 140 articles reporting case series through a search of MEDLINE and Embase analysing single hip replacement constructs, implanted for osteoarthritis

Summary

Introduction

Total hip replacement is one of the most common and effective forms of surgery, resulting in generally ex cellent outcomes.[1]. In the UK, the National Institute of Health and Care Excell ence set a benchmark in 2014, that individual com ponents making up a total hip replacement are only recommended for people with end-stage arthritis, if they have 10-year revision rates of 5% or lower.[2] The Orthopaedic Data Evaluation Panel assists in the implementation of this guidance, producing sum mary 10-year revision rates for individual prostheses using multiple data sources. At present, it does not publish revision rates for hip replacements, but only constituent parts

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