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

Chris M Penfold; Ashley W Blom; Adrian Sayers; J Mark Wilkinson; Linda Hunt; Andrew Judge; Michael R Whitehouse

doi:10.1136/bmjopen-2019-029572

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

BMJ Open. 2019 Nov 25;9(11):e029572. doi: 10.1136/bmjopen-2019-029572.

Authors

Chris M Penfold^{1

2}, Ashley W Blom^{3

2}, Adrian Sayers^{3

4}, J Mark Wilkinson^{5

6}, Linda Hunt³, Andrew Judge^{3

2}, Michael R Whitehouse^{3

2}

Affiliations

¹ Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK Chris.Penfold@bristol.ac.uk.
² National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
³ Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁴ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁵ Metabolic Bone Unit, Sorby Wing, Northern General Hospital, Sheffield, UK.
⁶ Department of Oncology and Metabolism and The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.

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 and (b) patients who used/received new rather than established components.

Design: Cohort of 618 393 primary THRs performed for osteoarthritis (±other indications) by 4979 surgeons between 2008 and 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 2005 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=1-3938) 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.

Keywords: implant; joint replacement; national joint registry; orthopaedics; patient; surgeon.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acetabulum / surgery*
Arthroplasty, Replacement, Hip / methods
Arthroplasty, Replacement, Hip / statistics & numerical data*
Cohort Studies
England
Follow-Up Studies
Hip Prosthesis / statistics & numerical data*
Humans
Osteoarthritis, Hip / surgery
Prosthesis Design
Prosthesis Failure / trends
Registries*
Retrospective Studies
Wales

Abstract

Publication types

MeSH terms

Grants and funding