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

• Published in: Health technology assessment (Winchester, England) England), 2015-01, Vol.19 (10), p.1-668
• Main Authors: Clarke, Aileen, Pulikottil-Jacob, Ruth, Grove, Amy, Freeman, Karoline, Mistry, Hema, Tsertsvadze, Alexander, Connock, Martin, Court, Rachel, Kandala, Ngianga-Bakwin, Costa, Matthew, Suri, Gaurav, Metcalfe, David, Crowther, Michael, Morrow, Sarah, Johnson, Samantha, Sutcliffe, Paul
• Format: Article
• Language: English
• Subjects: Age Factors; Arthroplasty, Replacement, Hip - economics; Arthroplasty, Replacement, Hip - methods; Cost-Benefit Analysis; disability; economic evaluation; hip; Humans; Models, Economic; osteoarthritis; Osteoarthritis, Hip - surgery; pain; Pain Management - economics; Pain Management - methods; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; resurfacing arthroplasty; Sex Factors; systematic review; Technology Assessment, Biomedical; total hip replacement
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/hta19100

Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies report