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Understanding the uptake of new hip replacement implants in the UK: a cohort study using data from the National Joint Registry for England and Wales
  1. Chris M Penfold1,2,
  2. Ashley W Blom1,2,
  3. Adrian Sayers1,3,
  4. J Mark Wilkinson4,5,
  5. Linda Hunt1,
  6. Andrew Judge1,2,
  7. Michael R Whitehouse1,2
  1. 1 Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
  3. 3 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  4. 4 Metabolic Bone Unit, Sorby Wing, Northern General Hospital, Sheffield, UK
  5. 5 Department of Oncology and Metabolism and The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Chris M Penfold; Chris.Penfold{at}


Objectives Primary: describe uptake of new implant components (femoral stem or acetabular cup/shell) for total hip replacements (THRs) in the National Joint Registry for England and Wales (NJR). Secondary: compare the characteristics of: (a) surgeons and (b) patients who used/received new rather than established components.

Design Cohort of 618 393 primary THRs performed for osteoarthritis (±other indications) by 4979 surgeons between 2008 and 2017 in England and Wales from the NJR. We described the uptake of new (first recorded use >2008, used within 5 years) stems/cups, and variation in uptake by surgeons (primary objectives). We explored surgeon-level and patient-level factors associated with use/receipt of new components with logistic regression models (secondary objectives).

Outcomes Primary outcomes: total number of new cups/stems, proportion of operations using new versus established components. Secondary outcomes: odds of: (a) a surgeon using a new cup/stem in a calendar-year, (b) a patient receiving a new rather than established cup/stem.

Results Sixty-eight new cups and 72 new stems were used in 47 606 primary THRs (7.7%) by 2005 surgeons (40.3%) 2008–2017. Surgeons used a median of one new stem and cup (25%–75%=1–2 both, max=10 cups, max=8 stems). Surgeons performed a median total of 22 THRs (25%–75%=5–124, range=1–3938) in the period 2008–2017. Surgeons used new stems in a median of 5.0% (25%–75%=1.3%–16.1%) and new cups in a median of 9.4% (25%–75%=2.8%–26.7%) of their THRs. Patients aged <55 years old versus those 55–80 had higher odds of receiving a new rather than established stem (OR=1.83, 95% CI=1.73–1.93) and cup (OR=1.31, 95% CI=1.25–1.37). Women had lower odds of receiving a new stem (OR=0.87, 95% CI=0.84–0.90), higher odds of receiving a new cup (OR=1.06, 95% CI=1.03–1.09).

Conclusions Large numbers of new THR components have been introduced in the NJR since 2008. 40% of surgeons have tried new components, with wide variation in how many types and frequency they have been used.

  • orthopaedics
  • joint replacement
  • implant
  • patient
  • surgeon
  • national joint registry

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  • Contributors CP, AB, AJ and MW designed the study. CP, AB, AS, JMW, LH, AJ and MW reviewed the published work. CP conducted the statistical analysis and wrote the manuscript. All authors contributed to critical review of the manuscript and its revision. CP had full access to all the data and AB is the guarantor.

  • Funding This study was funded by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. Adrian Sayers was supported by a MRC fellowship MR/L01226X/1.

  • Disclaimer The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or Healthcare Quality Improvement Partnership (who do not vouch for how the information is presented) or those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests AB and MW are involved in a separate grant to the University of Bristol funded by Stryker.

  • Patient consent for publication Not required.

  • Ethics approval Patient consent was obtained for data collection by the National Joint Registry. According to the specifications of the NHS Health Research Authority, separate informed consent and ethical approval were not required for the present study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Access to data is available from the National Joint Registry for England and Wales.

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