Editorials

Total hip replacement and NICE

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7487.318 (Published 10 February 2005) Cite this as: BMJ 2005;330:318
  1. Matthew R Utting, specialist registrar trauma and orthopaedics (mattutting@metronet.co.uk),
  2. B J A Lankester, specialist registrar trauma and orthopaedics,
  3. L K Smith, research assistant,
  4. R F Spencer, consultant orthopaedic surgeon
  1. Department of Orthopaedic Surgery, Weston General Hospital, Weston-super-Mare, Somerset BS23 4TQ
  2. Department of Orthopaedic Surgery, Weston General Hospital, Weston-super-Mare, Somerset BS23 4TQ

    New guidelines need to address several areas of uncertainty

    Around 150-200 different hip prostheses are available for use. Some require cement fixation, some are cementless, and each consists of an acetabular and a femoral component. The evolution of hip replacement led to alterations in design and materials, some of which proved disastrous (the 3M Capital implant is the best known failure).1 Guidelines for the selection of implants for hip replacement were introduced in the United Kingdom by the National Institute for Clinical Excellence (NICE) in 2000.2 Knowledge of the NICE guidelines is limited among both patients and clinicians, and a noteworthy number of surgeons in the United Kingdom are perhaps using prostheses that are not specified as suitable.3 Although guidelines do not suspend individual clinical autonomy, many surgeons are left in a quandary as to whether they are open to litigation.

    The NICE guidelines set a rate of revision for failure of 10% or …

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