Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0-79·2) and from joint replacement registries was 57·9% (95% CI 57·1-58·7). Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.
When a patient with hip osteoarthritis asks how long their replacement will last, quote the registry figure: roughly 58% survive 25 years, and about three quarters survive 15-20 years.
The central teaching point is critical appraisal. Case series gave a far rosier 77·6% at 25 years, but they are skewed by selection and publication bias, so the larger, population-based registry estimate is the one to trust.
This matters most for younger patients. The authors note younger age at implantation carries a higher lifetime risk of revision, so a 50-year-old should be counselled that they will likely outlive their first hip.
Remember that revision is a best-case definition of failure. Using long-term pain as the criterion, 7-23% of unrevised patients would also count as failures, so true patient-perceived success is lower than survivorship curves suggest. The historic implants studied are largely obsolete; modern constructs show 94·9% 15-year survival, so future longevity may exceed these estimates.
Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0-79·2) and from joint replacement registries was 57·9% (95% CI 57·1-58·7). Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.
When a patient with hip osteoarthritis asks how long their replacement will last, quote the registry figure: roughly 58% survive 25 years, and about three quarters survive 15-20 years.
The central teaching point is critical appraisal. Case series gave a far rosier 77·6% at 25 years, but they are skewed by selection and publication bias, so the larger, population-based registry estimate is the one to trust.
This matters most for younger patients. The authors note younger age at implantation carries a higher lifetime risk of revision, so a 50-year-old should be counselled that they will likely outlive their first hip.
Remember that revision is a best-case definition of failure. Using long-term pain as the criterion, 7-23% of unrevised patients would also count as failures, so true patient-perceived success is lower than survivorship curves suggest. The historic implants studied are largely obsolete; modern constructs show 94·9% 15-year survival, so future longevity may exceed these estimates.