title: Which implant should we use for primary total hip replacement? A systematic review and meta-analysis.
abstract: BACKGROUND
  Many total hip implants are currently available on the market worldwide. We aimed to estimate the probability of revision surgery at ten years for each individual total hip implant and to compare these estimates with the National Institute for Health and Care Excellence (NICE) benchmark.
  
  
  METHODS
  We performed a meta-analysis of cohort studies. The methodological quality was assessed with use of the Assessment of Quality in Lower Limb Arthroplasty (AQUILA) checklist. We searched PubMed, Embase, Web of Science, and the Cochrane Library. Additionally, national joint registries that were full members of the International Society of Arthroplasty Registers (ISAR) were hand searched. Studies in which the authors reported the survival probability for either the acetabular or the femoral component of primary total hip replacements with use of revision for any reason or for aseptic loosening at ten years as the end point, with at least 100 implants at baseline, and in which at least 60% of the patients had primary osteoarthritis were eligible for inclusion.
  
  
  RESULTS
  The search strategy revealed 5513 papers describing survival probabilities for thirty-four types of acetabular components and thirty-two types of femoral components. Eight types of acetabular cups and fifteen types of femoral stems performed better than the NICE benchmark.
  
  
  CONCLUSIONS
  We recommend that surgeons performing a primary total hip replacement use an implant that outperforms the NICE benchmarks.
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes: j.c.keurentjes@lumc.nl.
authors.forename: J Christiaan
authors.initials: JC
authors.lastname: Keurentjes
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes: j.c.keurentjes@lumc.nl.
authors.forename: Bart G
authors.initials: BG
authors.lastname: Pijls
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes: j.c.keurentjes@lumc.nl.
authors.forename: Floris R
authors.initials: FR
authors.lastname: Van Tol
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes: j.c.keurentjes@lumc.nl.
authors.forename: Jill F
authors.initials: JF
authors.lastname: Mentink
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes: j.c.keurentjes@lumc.nl.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Mes
authors.affiliation: Walaeus Library, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands.
authors.forename: Jan W
authors.initials: JW
authors.lastname: Schoones
authors.affiliation: Department of Medical Statistics and BioInformatics, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes: j.c.keurentjes@lumc.nl.
authors.forename: Rob G
authors.initials: RG
authors.lastname: Nelissen
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D011475:Prosthesis Failure; D016896:Treatment Outcome