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


METHODS
Retrospective cohort study.


METHODS
National Joint Registry.


METHODS
239 000 patient records.


METHODS
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.
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Ngianga-Bakwin
NB
Kandala
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Martin
M
Connock
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Ruth
R
Pulikottil-Jacob
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Paul
P
Sutcliffe
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
Michael J
MJ
Crowther
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Amy
A
Grove
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Hema
H
Mistry
Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK Aileen.Clarke@warwick.ac.uk.
Aileen
A
Clarke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000592:standards*; D019985:Benchmarking; D001843:Bone Cements / Q000627:therapeutic use*; D002516:Ceramics; D015331:Cohort Studies; D004739:England; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020959:Polyethylene; D012042:Registries; D012086:Reoperation / Q000592:standards; D012189:Retrospective Studies; D014852:Wales; D055815:Young Adult
D001843:Bone Cements; D008670:Metals; D020959:Polyethylene