Cemented metal-on-polyethylene implants best for seniors
Christopher G. Fawsitt, Ph.D., from the University of Bristol in the United Kingdom, and colleagues developed a Markov model to compare the cost-effectiveness of implants for total hip replacement among patients of different age and sex profiles. The authors estimated the probability that patients would require one or more revision surgeries from analyses of more than 1 million patients aged younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years and older.
The researchers found that for men and women older than 65 years, small-head cemented metal-on-polyethylene implants were the most cost-effective; the findings were robust to sensitivity analyses. They noted that uncemented, hybrid, reverse hybrid, and other bearing surface combinations performed poorly because of higher implant costs and poorer revision rates. For men and women aged younger than 65 years, small-head cemented ceramic-on-polyethylene implants yielded the highest incremental net monetary benefit; however, these results were more uncertain and revision rates were not precise.
"Our study can influence clinical practice and commissioning of services," the authors write. "We, however, highlight the need for rigorous randomized clinical trials with long-term follow-up before costly new implants are widely adopted in practice."
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