Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
BMJ. 2015 Mar 9;350:h756. doi: 10.1136/bmj.h756.
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.
Retrospective cohort study.
National Joint Registry.
239 000 patient records.
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.
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.
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.
比较常用于初次全髋关节置换的几种类型的 10 年翻修率，为在英格兰和威尔士设定新的具有国际相关性的基准率提供依据。
回顾性队列研究。
国家关节登记处。
239000 份患者记录。
5 种常用全髋关节置换类型的翻修率，这些类型根据轴承表面和固定方式的不同而有所不同，涵盖了英格兰和威尔士国家关节登记处所有初次全髋关节置换的 62%。使用 Kaplan-Meier 和竞争风险分析比较翻修率，并使用拟合良好的参数模型估计 5 年和 10 年的翻修率。
在所研究的 5 种全髋关节置换类型中，有 4 种的 10 年估计翻修率为 4%或更低。Kaplan-Meier 或竞争风险分析的结果差异不大，但假体类型之间的差异更为显著。带陶瓷-聚乙烯轴承表面的骨水泥假体的翻修率最低（10 年时的翻修率为 1.88%-2.11%，具体取决于使用的方法），带陶瓷-陶瓷轴承表面的非骨水泥假体的翻修率最高（3.93%-4.33%）。男性接受全髋关节置换翻修的可能性高于女性，在 5 种假体类型中有 4 种的这种差异具有统计学意义。
10 年翻修率估计均低于 5%，在某些情况下，甚至低很多。结果表明，目前的翻修率基准应至少减半，从 10%降至 10 年时的 5%以下。这对国际基准有影响。
