Study reveals hip and knee replacement performance in England and Wales

April 29, 2019

The performance of different prosthetic implant combinations used in patients undergoing hip and knee replacements in England and Wales over the last 14 years have, for the first time, been directly compared in two new studies. The University of Bristol findings, published in the BMJ Open today [Tuesday 30 April], reveal substantial variability in the performance of different joint replacements, and the number of patients requiring a second surgery.

Using data from the the largest joint replacement register in the world -- the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man, researchers from Bristol's Musculoskeletal Research Unit and Wrightington Hospital, assessed 4,442 different hip implants used in 797,178 hip replacements, and 449 different types of knee implants used in 947,686 knee replacements between 1 April 2003 and 31 December 2016.

Failure estimates (the number of procedures requiring a second surgery) of each hip or knee implant brand were compared to the best performing hip or knee implant in the ten years following surgery. The large data set allowed the analysis to be performed for men and women of different ages.

Two thresholds were used for defining the performance of an implant, the first being that implants were at least 100 per cent worse (double the failure rate) than the benchmark implant, the second being that they were at least 20 per cent worse than the benchmark implant.

In analyses of hip replacements at ten years following surgery, it was found that of the 26 implant combinations, with enough data to enable analysis, one had at least a 100 per cent higher risk of revision than the benchmark implant and 11 others had at least 20 per cent higher risk. For knee replacements of the 27 that could be compared at ten years, two implants had at least 100 per cent higher risk of revision and 16 had at least 20 per cent higher risk of revision. Separate analyses of men and women and of different ages illustrate that some implants perform well in some groups, but not others.

Kevin Deere, Senior Research Associate from Bristol's Musculoskeletal Research Unit and lead author on the studies, commented: "We have shown that commonly used hip and knee replacements can have excellent results with very low failure rates. However, there is variation in performance and many implants have been used in too few cases to allow meaningful comparison."

Adrian Sayers, the studies' senior author from Bristol's Musculoskeletal Research Unit in the Bristol Medical School; Translational Health Sciences (THS), added: "This is first time that all the different implant combinations used in England and Wales in the last 14 years have been directly compared, and results are available to everyone. This gives patients the opportunity to discuss with their surgeon the choice of implants they intend to use and see how they perform in comparison to other implants. This research will empower patients and surgeons and help in the decision-making process."

Martyn Porter, hip surgeon and previous President of the British Orthopaedic Association, said: "The data produced by this study is very powerful. It allows patients, surgeons and others interested in the care of patients undergoing joint replacement to have a contemporary and relevant reference for comparison of revision rates. Whilst the rate of revision is only one of the metrics by which the success of joint replacement is judged, it is one that is often important to patients. This data is the beginning of a discussion that patients can have with their surgeon around the type of joint replacement that they might have."
The studies were funded by the Medical Research Council and National Institute for Health Research (NIHR) Bristol Biomedical Research Centre (BRC).


'Assessing the non-inferiority of prosthesis constructs used in hip replacement using data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man: A Benchmarking study' by Kevin Deere, Michael R Whitehouse, Martyn L Porter, Ashley W Blom, Adrian Sayers in BMJ Open 2019

'Assessing the non-inferiority of prosthesis used in total and unicondylar knee replacements using data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man: A benchmarking study' by Kevin Deere, Michael R Whitehouse, Martyn L Porter, Ashley W Blom, Adrian Sayers in BMJ Open 2019

University of Bristol

Related Joint Replacement Articles from Brightsurf:

Researchers use lab-grown tissue grafts for personalized joint replacement
A multidisciplinary team from Columbia Engineering, Columbia's College of Dental Medicine and Department of Medicine, Louisiana State University, LaCell LLC, and Obatala Sciences has now bioengineered living cartilage-bone temporomandibular joint grafts, precisely matched to the recipient, both biologically and anatomically.

After Medicaid expansion, 'unmet need' for joint replacement surgery
States that have expanded Medicaid eligibility under the Affordable Care Act have seen an 'early surge in demand' for hip and knee replacement surgery, reports a study in the September 2, 2020 issue of The Journal of Bone & Joint Surgery.

Osteoarthritis: Conservative therapy delays need for knee and hip joint replacement surgery
With implementation of conservative treatment methods like physiotherapy and individually tailored, adjusted exercises, quality of osteoarthritis care can improve and patients can delay the need for an artificial hip or knee joint.

Translating skeletal movements, joint by joint
A global team of computer scientists has developed a novel deep-learning framework that automates the precise translation of human motion, specifically accounting for the wide array of skeletal structures and joints.

Does your cat have degenerative joint disease?
With an estimated 10-15% of adults over the age of 60 having some degree of osteoarthritis, otherwise known as degenerative joint disease (DJD), many people will be familiar with, or will know someone who suffers from, this painful and debilitating condition.

Bundled payments have not led to 'cherry-picking' of patients for joint replacement surgery
A pilot program introducing bundled payments for hip and knee replacement (HKR) in Medicare patients hasn't led hospitals to 'cherry-pick' healthier patients at lower risk of complications, reports a study in the February 19, 2020 issue of The Journal of Bone & Joint Surgery.

Link found between gut bacteria, successful joint replacement
Having healthy gut flora -- the trillions of bacteria housed in our intestines -- could lower the risk of infection following knee and hip replacement surgeries, while an unhealthy intestinal flora may increase the risk of infection.

Low income is a risk factor for 'catastrophic' amputation after knee joint replacement
Above-knee amputation (AKA) is a rare but severe complication of deep infection after knee replacement surgery.

No increased risk of complications for joint replacement in ambulatory surgery setting
Researchers conducted a study to compare patient outcomes and costs for in-patient hip and knee replacement surgeries to those performed in an ambulatory surgery center.

A model for more efficient use of resources after joint replacement surgery
Patients who live close to the hospital at which they have had a hip or knee replacement are much more likely to visit the emergency room for follow-up care of pain, inflammation and other complaints than those who live farther away, according to a new study.

Read More: Joint Replacement News and Joint Replacement Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to