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Editorials Evidence-Based Choice of hip Prosthesis

JBJS VOL. 78-B, NO. 5, SEPTEMBER 1996, pp. 691-693

By Morris, R.

The prostheses in current use for hip replacement vary in cost by a factor of nearly ten (Murray, Carr and Bulstrode 1995). Since more than 40 000 hip arthroplasties are performed annually in the UK, it is clear that research is needed to establish whether the varying cost is related to long-term survival in patients and to the outcome as regards comfort and quality of life. In 1995, the National Health Service Research and Development Programme commissioned a systematic review which aimed at
estimating the relative effectiveness of different prostheses.

In this issue of the Journal, there is a report of a long follow-up of the early Charnley and Stanmore prostheses by Britton et al (p.802-8). This suggests that the Charnley design, which accounts for about half of the hip prostheses implanted in the UK (Hashemi-Nejad, Birch and Goddard 1994), has a ten-year survival which is inferior by about 9%. It is of interest that the results for the Charnley implant are less good than those reported from major centres such as Wrightington and the Mayo Clinic. If this comparison is true, the difference between the implants is important in terms of the cost and clinical workload required for later revision surgery.

Orthopaedic procedures have usually been evaluated by means of case series (Morris 1988), and this is particularly true of the alternative prostheses available for hip replacement. This means that a valid comparison of series is virtually impossible: they come from different centres, with a widely differing selection of patients and measurement of outcome. There is a similar situation in general surgery, as emphasised in a recent Lancet editorial (Horton 1996).

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