Setting benchmark revision rates for total hip replacement: analysis of registry evidence

Kandala, Ngianga-Bakwin, Connock, Martin, Pulikottil-Jacob, Ruth, Crowther, Michael, Grove, Amy and Clarke, Aileen (2015) Setting benchmark revision rates for total hip replacement: analysis of registry evidence. BMJ, 350. h756. ISSN 1756-1833

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Abstract

Objective - To compare 10 year revision rates for frequently used types of primary total hip replacement to inform setting of a new benchmark rate in England and Wales that will be of international relevance.

Design - Retrospective cohort study.

Setting - National Joint Registry.

Participants - 239 000 patient records.

Main outcome measures - Revision rates for five frequently used types of total hip replacement that differed according to bearing surface and fixation mode, encompassing 62% of all primary total hip replacements in the National Joint Registry for England and Wales. Revision rates were compared using Kaplan-Meier and competing risks analyses, and five and 10 year rates were estimated using well fitting parametric models.

Results - Estimated revision rates at 10 years were 4% or below for four of the five types of total hip replacement investigated. Rates differed little according to Kaplan-Meier or competing risks analysis, but differences between prosthesis types were more substantial. Cemented prostheses with ceramic-on-polyethylene bearing surfaces had the lowest revision rates (1.88-2.11% at 10 years depending on the method used), and cementless prostheses with ceramic-on-ceramic bearing surfaces had the highest revision rates (3.93-4.33%). Men were more likely to receive revision of total hip replacement than were women, and this difference was statistically significant for four of the five prosthesis types.

Conclusions - Ten year revision rate estimates were all less than 5%, and in some instances considerably less. The results suggest that the current revision rate benchmark should be at least halved from 10% to less than 5% at 10 years. This has implications for benchmarks internationally.

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