Extended benchmarking in total hip replacement

  • Jonathan T Evans

Student thesis: Doctoral ThesisDoctor of Medicine (MD)


Over one million total hip replacements (THRs) are performed worldwide every year and in general, provide cost effective pain relief and improved function for people with end-stage osteoarthritis (OA). Given time, all THRs will fail and many of those that do require revision surgery, which is costlier and less effective than the primary operation. Many different THR prostheses are available and variation in their survival has been observed. This thesis aims to predict the long-term (greater than 15-year) revision rate of THRs using the Princess Elizabeth Orthopaedic Centre, Exeter (PEOC) local database and the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (NJR) to help inform minimum acceptable performance standards (benchmarks).
The revision rate of THRs from PEOC was compared to the to the rest of the country using NJR data to prove generalisability of survival results from PEOC. A predictive algorithm adjusting for age and gender was developed, based on the PEOC database, using flexible parametric survival analysis and then applied to the NJR dataset as an out of sample estimate.
The predicted revision rate, for the contemporary prostheses combinations used in PEOC, after 10 years was 2.2% (95% CI 1.8, 2.7) which was validated by NJR data. An extrapolated prediction at 30 years suggests an all cause revision rate of 6.5% (95% CI 4.5, 9.4).
The predicted revision rate for these prostheses combinations after 10 years is well below the 5% revision benchmark currently set by the National Institute for Health and Care Excellence (NICE). This thesis supports lowering of the existing benchmark and extending it past 10 years to ensure as many patients as possible receive optimum standards of care.
Date of Award1 Oct 2019
Original languageEnglish
Awarding Institution
  • The University of Bristol
SponsorsRoyal College of Surgeons & National Joint Registry for England, Wales, Northern Ireland and the Isle of Man
SupervisorMichael R Whitehouse (Supervisor) & Adrian E Sayers (Supervisor)

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