A Comparison of the Survival of Total Hip Replacement Inserted over Two Sequential Time Periods

Modifications in design and surgical technique have been directed at improving the long-term survival of total hip replacement. This study examines the failure rate, with revision as endpoint, of two large cohorts of primary total hip replacement carried out over consecutive six-year intervals. The intention of the study was not to compare specific prostheses or techniques, but to examine failure rates between two time periods which embraced significant changes of practice. At one specialised centre in Bristol, 2747 primary total hip replacements were performed between 1980 and 1986. Seventy-six failed within 5 years (2.8%) with 23 of these failing in the first year (0.8%). Between 1987 and 1992, 3232 primary total hip replacements were carried out, with 98 hips requiring revision within 5 years (3.0%), 21 of these in the first year (0.6%). There was no statistical difference in the incidence of failure between these two time periods; however, the failure rate for the more recent time period was marginally higher. This indicates that, although techniques and prosthetic design have changed significantly, the anticipated reduction in incidence of failure has not materialised. There is undoubtedly a need for ongoing review to ensure that changes in technique and component design are producing the desired long-term effect.