Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisInnovative hip and knee replacement devices do not improve function more than conventional devices and may increase need for revision surgery
Nieuwenhuijse MJ, Nelissen RG, Schoones JW, et al. Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies. BMJ. 2014;349:g5133.
Review question
In people with symptomatic osteoarthritis who need total hip or total knee replacement, are newer implantable devices effective and safe compared with conventional devices?
Background
Some people who have symptomatic osteoarthritis of the hip or knee need to have joint replacement surgery. The damaged joint surfaces are removed and replaced with plastic, metal, or ceramic parts. Ideally, replacing the joint improves function and movement of the hips or knees. Sometimes these artificial joints wear out or come loose and need to be replaced (revision surgery). There have been a number of innovations in artificial joint devices. The innovative devices are widely used in joint replacement surgery, but we don’t know if they are better than conventional devices.
How the review was done
The researchers did a systematic review, searching for published studies up to April 2014. They found 118 studies of 94 cohorts, with 13,164 people.
In the studies, people 21 years or older were having their first total hip or knee replacement for symptomatic primary or secondary osteoarthritis.
Newer joint replacement devices were compared with a conventional device.
Newer devices for total hip replacement included ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock (not metal-on-metal) acetabular cups.
Newer devices for total knee replacement included high-flexion implants and gender-specific implants.
What the researchers found
Studies of 9 cohorts were of high quality, 14 were moderate to high quality, 17 were moderate quality, and the rest were low to moderate or low quality.
There was no high-quality evidence that newer devices improved function.
Newer devices may increase the rate of revision surgery.
Conclusion
In people with osteoarthritis having total hip or knee replacement, newer innovative devices do not perform better than conventional devices and may increase the rate of revision surgery.
Newer total hip or knee replacement devices vs conventional devices in people with osteoarthritis
| Type of surgery | Device type | Number of cohorts (number of people) | Effect of newer device on function and flexion | Effect of newer device on safety* |
| Total hip replacement | Ceramic-on-ceramic articulation | 23 cohorts (4,807 people) | No difference in function Squeaking occurred only in new-device group | Increased revision rate No difference in complications |
|
| Uncemented monoblock acetabular component | 5 cohorts (540 people) | No difference in function | No difference in revision rate |
| Total knee replacement | High-flexion components | 52 cohorts (5,769 people) | No clinically relevant increase in flexion No difference in other outcomes | Increased revision rate |
|
| Gender-specific components | 10 cohorts (1,396 people) | No clinically relevant increase in flexion No difference in other outcomes | No difference in revision rate |
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Glossary
A comprehensive evaluation of the available research evidence on a particular topic.
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