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Clarke A, Pulikottil-Jacob R, Grove A, et al. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2015 Jan. (Health Technology Assessment, No. 19.10.)

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Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation.

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Appendix 24Revision rates in studies with extended follow-up

The RCT by Kim et al.126 reported an extended follow-up to about 20 years. The reported revision rates were higher between 15 and 20 years than between 10 and 15 years.

The bathtub model of hazard for revision implies that revision rates will gradually increase at some time after plateauing. The trajectory of revision during substantial follow-up beyond the plateau is required to see if this is reasonable; however, it should be borne in mind that long follow-up times (e.g. up to 20 years) necessitate looking at devices and practices that may now no longer be widely used. The NJR data provided observed rates to between 9 and 10 years only; we looked elsewhere for relevant information on the trajectory of revision rates over the long term.

The SHAR provides relevant information for up to 19 years of follow-up (Figure 95). This shows increasing rates of revision from about 5 to 15 years for age groups other than 60- to 75-year-old patients. For these age groups these data are consistent with a bathtub hazard. For the oldest age group revision rates are relatively low and are not consistent with the bathtub model.

FIGURE 95. Swedish registry data for time to revision up to 19 years of follow-up (1992–2010).

FIGURE 95

Swedish registry data for time to revision up to 19 years of follow-up (1992–2010). (a) Patients aged < 50 years; (b) patients aged between 50 and 59 years; (c) patients aged between 60 and 75 years; and (d) patients aged > 75 (more...)

Some small observational studies368–370 with long follow-up times also support the bathtub model. The results from these are summarised in Figure 96.

FIGURE 96. Time to revision results reproduced with permission from (a) Schulte et al.

FIGURE 96

Time to revision results reproduced with permission from (a) Schulte et al.; (b) Madey et al.; and (c) Callaghan et al.

Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Clarke et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK273963
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