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Carroll C, Stevenson M, Scope A, et al. Hemiarthroplasty and Total Hip Arthroplasty for Treating Primary Intracapsular Fracture of the Hip: A Systematic Review and Cost-Effectiveness Analysis. Southampton (UK): NIHR Evaluation, Trials and Studies Coordinating Centre (UK); 2011 Oct. (Health Technology Assessment, No. 15.36.)

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Hemiarthroplasty and Total Hip Arthroplasty for Treating Primary Intracapsular Fracture of the Hip: A Systematic Review and Cost-Effectiveness Analysis.

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7Conclusions

Implications for service provision

Total hip arthroplasty appears to be more cost-effective than HA, although it is likely that this will be associated with increased costs in the initial 2-year period. The longer-term reduction in costs owing to potentially lower revision rates associated with THA have not been estimated. The capacity and experience of surgeons to perform THA have not been explored and these would need to be addressed at local level were THA to become recommended for active, elderly patients who were not contraindicated for THA.

Suggested research priorities

Eight head-to-head RCTs of THA and HA have currently been published. The EVPI per patient has been estimated, although it is expected that there is limited value in conducting a new trial comparing THA and HA as three such trials are ongoing at the time of writing. The biggest of these trials [Comparing Total Hip Arthroplasty and Hemi-Arthroplasty on Revision Surgery and Quality of Life in Adults With Displaced Hip Fractures (the HEALTH study): NCT00556842] has an estimated enrolment of 306 participants. Some of the published trials may also report more data as they become available. Furthermore, the findings of these trials are generally consistent regarding the relative efficacy and trends of the two interventions in terms of dislocation rates, revision rates, hip scores and quality of life. These findings do not appear to be affected by potential confounding variables identified in the literature (i.e. study quality, surgical approach, the use of cement and unipolar of bipolar hemiarthroplasty prostheses), as far as these data were available and permitted relevant subgroup analysis. However, further studies examining the impact of surgeons' experience in performing the two procedures (i.e. THA and HA each being performed by surgeons equally experienced in the respective procedures) may offer some more robust evidence on outcomes.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK98309
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