Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
"Guidance from the National Institute for Health and Care Excellence says that THRs should be recommended for treatment of end stage osteoarthritis of the hip only if the prostheses have rates of failure (or projected rates of failure) of 10% or less at 10 years or, as a minimum, a three year revision rate consistent with this."
BMJ readers and NIHR representatives alike may be interested to know that the current NICE document titled "Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip (TA304)" which replaces NICE technology appraisal guidance 2 (TA2) issued in April 2000 and NICE technology appraisal guidance 44 (TA44) in June 2002, states:
"Prostheses for total hip replacement and resurfacing arthroplasty are recommended as treatment options for people with end-stage arthritis of the hip only if the prostheses have rates (or projected rates) of revision of 5% or less at 10 years."
I believe the original 10% failure or less at 10 years (attributed by the NIHR authors as a TA304 standard) was actually a TA2 standard but it is no longer acceptable particularly when there are so many implants available that can do much better than that. Most practising arthroplasty surgeons would agree with this assessment.
1. National Institute for Health and Care Excellence. Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip. TA304. 2014