New research led by the Hip Implant Prosthesis Study team at the University of Bristol suggest that for older patients the small-head cemented metal-on-polyethylene implant is the most likely cost-effective choice in primary total hip replacement (THR).
Data from 2 large national cohorts, the National Joint Registry for England, Wales, and the Northern Ireland and the Swedish Hip Arthroplasty Register, showed that small-head (less than 36 mm in diameter) cemented metal-on-polyethylene hip replacements are the most cost-effective option in men and women older than 65 years. However, for adults younger than 65, small-head cemented ceramic-on-polyethylene hip replacements are more likely to be cost-effective option. The study found no evidence that uncemented or hybrid implants are cost-effective options, while large-head implant sizes (more than 36 mm) are not cost-effective.
Small-head cemented metal-on-polyethylene implant is the most common implant combination in the United Kingdom, used in 30% of THR patients since 2003/2004.
Lead author, Dr Elsa Marques from the Musculoskeletal Research Unit at the University of Bristol said: "Small-head cemented metal-on-polyethylene implants have the longest track-record of use; they are safe and the cheapest implant type on the market but tend only to be favoured for older patients. Currently only 30% of patients in the NHS are offered a cemented implant, whereas the uptake of uncemented implants has been rising in the United Kingdom in the last 10 years, particularly for younger adults.”
"Our findings produce new evidence to inform clinical practice. Regardless of their bearing material, there is no effectiveness or cost-effectiveness evidence that uncemented implants last longer and avoid revision surgeries for any patient group. We hope this information will help patients, clinicians, and decision-makers make better informed decisions for patients and reduce the financial burden of hip replacement surgeries," she said.
