Hip arthroplasty (choice of implant)

For the treatment of

Any indication for total hip replacement e.g. degenerative hip disease or fracture

Commissioning position

This intervention is commissioned if the choice of implant is as follows:

Patients aged 70 and over:

  • metal head and a cemented stem
  • acetabular fixation can be cemented (Fully cemented THR) OR uncemented (Hybrid THR), bearing in mind that a cemented socket is considerably cheaper
  • alternative (uncemented) femoral fixation may be selected in patients with anatomical irregularity, at the discretion of the operating surgeon.

 

Patients aged under 70:

  • ceramic head and highly cross-linked polyethylene liner/cup
  • ceramic liners may be used for patients aged <50yrs, due to lower wear rates, at the discretion of the operating surgeon.

 

In all cases, the implant chosen should have a revision rate (with reference to e.g. National Joint Registry or ODEP) of 5% or less at 10 years.

Providers should be able to demonstrate from internal audit that a minimum 80% patients aged 70+ had cemented/hybrid hips replacement.

Summary of rationale

The cost effectiveness of different implants varies across age groups because revision rates depend on a patient’s age at primary surgery. More expensive implants can be more cost effective in younger patients. Anatomical irregularity may justify uncemented femoral fixation.

Ceramic heads and highly cross-linked polyethylene liners/cup have the lowest rate of revision for all fixation constructs.

Beside the additional cost, revision surgery is more complicated than primary surgery.

Date created: 08/07/2025, 11:39
Last modified: 20/08/2025, 15:34
Date of review: 2028. 12. 31.