Selection of primary hip and knee arthroplasties for public hospitals in Western Australia: a clinical evidence approach.
BACKGROUND
The Australian Joint Registry records that there are approximately 84 hip stem designs, 71 acetabular designs and 45 knee systems in common use in Australia, giving the surgeon an extensive and often bewildering choices.


METHODS
Since the 1990s, there have been several attempts to rationalize the supply of the products of primary hip and knee arthroplasties to the public hospitals in Western Australia. To continue and improve the rationalization process, the recently awarded 'whole of health' tender was based on a thorough clinical and laboratory evaluation process. The method included commercial analysis by Health Supply Western Australia, clinical evaluation by a committee comprised of senior surgeons and technical assessment by biomedical engineers and scientists. The evaluation process was subdivided into qualitative criteria; being the commercial aspects of the tender (50%) and a fitness for purpose assessment comprising clinically based evidence (40%) and laboratory assessment of product quality (10%).


RESULTS
The tendering process concluded with the recommendation of 12 hip and 5 knee systems.


CONCLUSIONS
A comprehensive method primarily based on clinical evidence was used to assess arthroplasty products tendered to Western Australia public hospitals. Generally, there was good compliance with the commercial aspects of the tender. In contrast, however, clinically based evidence assessment of many arthroplasty devices was difficult because of a distinct lack of quality published work. Inadequate quality control of several devices is also of concern. Evaluation of key performance indicators, including cost savings, acceptance by surgeons, tender compliance and revision rates, will determine the success of the tender.
Kop
Alan M
AM
Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia. alan.kop@health.wa.gov.au
Swarts
Eric
E
D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D006622:Hip Prosthesis; D006779:Hospitals, Public; D006801:Humans; D007720:Knee Prosthesis; D008422:Materials Testing; D011474:Prosthesis Design; D011786:Quality Control; D014904:Western Australia