Understanding the uptake of new hip replacement implants in the UK: a cohort study using data from the National Joint Registry for England and Wales

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Abstract

Objectives Primary: describe uptake of new implant components (femoral stem or acetabular cup/shell) for total hip replacements (THRs) in the National Joint Registry for England and Wales (NJR). Secondary: compare the characteristics of: a) surgeons b) patients who used/received new rather than established components.
Design Cohort of 618,393 primary THRs performed for osteoarthritis (±other indications) by 4,979 surgeons between 2008-2017 in England and Wales from the NJR. We described the uptake of new (first recorded use >2008, used within 5 years) stems/cups, and variation in uptake by surgeons (primary objectives). We explored surgeon-level and patient-level factors associated with use/receipt of new components with logistic regression models (secondary objectives). 
Outcomes Primary outcomes: total number of new cups/stems, proportion of operations using new versus established components. Secondary outcomes: odds of: a) a surgeon using a new cup/stem in a calendar-year, b) a patient receiving a new rather than established cup/stem.
Results Sixty-eight new cups and 72 new stems were used in 47,606 primary THRs (7.7%) by 2,005 surgeons (40.3%) 2008-2017. Surgeons used a median of one new stem and cup (25%-75%=1-2 both, max=10 cups, max=8 stems). Surgeons performed a median total of 22 THRs (25%-75%=5-124, range=1-3,938) in the period 2008-2017. Surgeons used new stems in a median of 5.0% (25%-75%=1.3-16.1%) and new cups in a median of 9.4% (25%-75%=2.8-26.7%) of their THRs. Patients aged <55 years old versus those 55-80 had higher odds of receiving a new rather than established stem (OR=1.83, 95%CI=1.73-1.93) and cup (OR=1.31, 95%CI=1.25-1.37). Women had lower odds of receiving a new stem (OR=0.87, 95%CI=0.84-0.90), higher odds of receiving a new cup (OR=1.06, 95%CI=1.03-1.09).
Conclusions Large numbers of new THR components have been introduced in the NJR since 2008. 40% of surgeons have tried new components, with wide variation in how many types and frequency they have been used.
Original languageEnglish
Article numbere029572
Number of pages10
JournalBMJ Open
Volume9
Issue number11
DOIs
Publication statusPublished - 25 Nov 2019

Keywords

  • implant
  • joint replacement
  • national joint registry
  • orthopaedics
  • patient
  • surgeon

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