Table 2.
Overview of results from systematic review of trials, comparative studies, and registries for comparative effectiveness and safety of five implantable device innovations
| Device innovation | Total hip replacement | Total knee replacement | ||||
|---|---|---|---|---|---|---|
| Ceramic-on-ceramic articulation | Modular femoral neck | Uncemented monoblock acetebular component | High flexion components | Gender specific components | ||
| Comparative effectiveness | ||||||
| No of included cohorts (in studies) | 23 (in 42) | 4 (in 4) | 5 (in 5) | 52 (in 56) | 10 (in 11) | |
| No of implants (patients) | 5442 (4807) | 1730 (1700) | 546 (540) | 6835 (5769) | 1879 (1396) | |
| Follow-up term No of cohorts) | Short term (7) Mid-term (10) Long term (6) |
Short term (2) Long term (1) Unknown (1) |
Short term (2) Mid-term (3) |
Short term (41) Mid-term (9) Long term (2) |
Short term (10) | |
| Study quality (No of cohorts) | High (1) Moderate to high (4) Moderate (6) Low to moderate (7) Low (5) |
Moderate (1) Low to moderate (2) Low (1) |
Moderate to high (1) Low to moderate (1) Low (3) |
High (7) Moderate to high (6) Moderate (7) Low to moderate (10) Low (22) |
High (1) Moderate to high (3) Moderate (3) Low to moderate (1) Low (2) |
|
| Main reported outcomes (No of cohorts) | Harris Hip Score (16) WOMAC (5) Squeaking (10) |
Harris Hip Score (2) Hip flexion (1) Dislocation rate (4) |
Harris Hip Score (2) Oxford Hip Score (2) Preference (2) |
Knee flexion (52) Knee Society Score (32) Knee Society function (26) |
Knee range of motion (10) Knee Society Score (6) WOMAC (4) |
|
| Results from reported differences and pooled estimates | No significant differences,* squeaking only in CoC group | Harris Hip Score significantly higher, dislocations comparable | No significant differences | Clinically irrelevant increased flexion,* no difference other outcomes* | Clinically irrelevant increased range of motion,* no difference other outcomes* | |
| Conclusion | No evidence for clinically relevant improvement | Insufficient evidence for clinically relevant improvement | No evidence for clinically relevant improvement | No evidence for clinically relevant improvement | No evidence for clinically relevant improvement | |
| Safety and survival | ||||||
| Registries with relevant data | Australia, New Zealand, UK, Medicare | Australia, Italy | New Zealand, Sweden, US | Australia, New Zealand, Sweden, Denmark, US | Sweden, Denmark, US | |
| No of implants | 99 132 CoC 338 405 MoP 75 989 CoP |
34 065 modular neck 212 800 conventional |
11 345 monoblock cups 37 142 modular cups |
57 955 high flexion 537 560 conventional |
3917 gender specific 3578 conventional |
|
| Revision rate | Slightly higher compared with MoP (HR 1.0 to 1.55) |
Nearly doubled (HR 1.92) |
Comparable | Slightly higher for most common high flexion designs (HR 1.0 to 1.76) |
Comparable | |
| Complications | Comparable | Higher rate of dislocation and implant fracture | Not reported | Not reported | Not reported | |
| Conclusion | Revision rate may be higher | Revision and complication rate higher | Comparable revision rate | Revision rate may be higher | Comparable revision rate | |
WOMAC=Western Ontario and McMaster Universities Arthritis Index, CoC=ceramic-on-ceramic, MoP=metal-on-polyethylene, CoP=ceramic-on-polyethylene, HR=hazard ratio
*Includes pooled estimates.