November 21, 2013
NICE draft guidance update on hip replacement and resurfacing recommends more
reliable artificial joints
NICE is updating its guidance on providing people who need hip replacements with
the right prosthesis for their requirements. The updated draft recommendations
include a stricter benchmark for the quality of hip prostheses, proposing that
the new joint should work well in at least 95% of cases over 10 years, instead
of the current 90% of cases.
Hip replacements or resurfacing are often needed to improve mobility problems
and severe discomfort caused by rheumatoid arthritis or osteoarthritis in the
hip joint. Arthritis is a very common and painful condition – it affects more
than 3 million people in the UK. Someone with arthritis can experience
significant pain and stiffness which will limit everyday tasks such as walking,
climbing stairs and performing household tasks. However, a successful hip
replacement can completely relieve pain and disability associated with arthritis
of the hip when exercise, physiotherapy or medicines no longer work.
Around 60,000 operations to replace hips are carried out in the NHS in England
and Wales each year with a further 25,000 carried out in independent hospitals.
Nevertheless, sometimes wear or other problems with the artificial joint mean
that it has to be replaced. This replacement is called a ‘revision’.
Commenting on the draft guidance, Professor Carole Longson, Director of the
Centre for Health Technology Evaluation at NICE said: "This new draft guidance
for those with arthritis of the hip who have already tried non-surgical
treatments such as exercise, physical therapy or painkillers, will help ensure
they receive the best possible prosthesis for them."
"Importantly, as we now have more information about how long artificial joints
can last, we have recommended the use of prostheses with a proven lower revision
rate. This means that a new joint should work well in at least 95% of cases over
10 years, so a revision may be needed in 5% or fewer cases over this period. Our
existing guidance advises that prostheses should work well in at least 90% of
cases, so repeat surgery may be needed in up to 10% of cases over 10 years. The
proposed improvement to the benchmark for the revision rate is good news for
people with hip replacements or hips resurfacing – more people can expect their
prostheses to continue working well over 10 years."
This new appraisal reviews previous NICE guidance on total hip replacement and
metal hip resurfacing. Since the original recommendations were published, more
information has become available on how often the artificial hip joints and
resurfacing would need to be replaced or the ‘revision rate’. Current NICE
guidance recommends a revision rate of 1 in 10 (10%) after 10 years as a
‘benchmark’ in the selection of artificial joints. The new draft guidance
recommends a rate (or projected rate) of revision of less than 1 in 20 (5%)
after 10 years.
What type of hip replacement prostheses a patient receives depends on various
factors, such as a patient’s age and underlying hip physiology, as well as the
surgeon’s choice and experience of using a particular class of prosthesis.
Consultees, including the manufacturers, healthcare professionals and members of
the public are now able to comment on the preliminary recommendations which are
available for public consultation. Comments received during this consultation
will be fully considered by the Committee and following this meeting the next
draft guidance will be issued.