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February 2001 “Does
NICE appraisal on hip replacement fail patients?” Suppliers of hip prostheses and leading
Orthopaedic Surgeons have described the recent National Institute of Clinical
Excellence (NICE) technology appraisal on total hip replacements (THR) as
ineffective. Independent analysis by medical device
marketing consultancy Joint Solutions Ltd has indicated that the NICE
recommendations have had virtually no effect on current practice in THR
surgery in the UK. “Evidence
suggests that the majority of hospitals and surgeons continue to use the
prostheses they were using before the publication of the NICE report on THR,”
said Michael Green, Director of Joint Solutions. It seems that both industry members and
healthcare professionals were disappointed by the NICE findings. A majority of those polled felt that NICE
had shied away from strong recommendations and had left the door open to
unproven implant designs. “It is clear from a large body of
published data, including the Scandinavian hip registers, that surgeons
should ideally be using one of only four or five implants with proven,
acceptable results from quality studies over ten years or more. There is no
evidence to support the use of newer unproven devices, unless this is in
centres of excellence for hip surgery and within controlled clinical trials,”
continues Mr Green. “The other
key issues raised by the Joint Solutions research are those of training and
clinical experience; using a proven device per se does not guarantee good
results”. Surgeon experience and
technique are factors that were raised in the NICE appraisal of THR. In the UK the number of different
brands of hip implants used continues to be in excess of fifty. The general opinion of both industry
and surgeons is that an opportunity to achieve the best result for THR patients
by recommending the four leading prostheses, Charnley, Exeter, Stanmore, and
Lubinus has been missed.
Instead, the NHS has not yet enforced the NICE findings and
guidelines. The re-issue of NICE guidelines on
total hip prostheses is due in 2002, with other orthopaedic procedures
possibly due for appraisal before this time. The orthopaedic community will eagerly await NICE’s next
findings. Mr Green concludes, “It was claimed
that £8 million could be saved by the implementation of these
guidelines. However, to date there
is no evidence of savings that have been made through change of
practice. Patients can only hope
that when the guidelines are reviewed in 2002 there is a more authoritative
line taken by NHS Trusts based on the facts available to them. Orthopaedic implant companies also
need to be aware of this impending review.” For more information contact: Michael Green Joint Solutions Ltd Ph. +44
(0)1428 656 099 Fax. +44
(0)1428 656 088
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