Joint responsibility: the need for a national arthroplasty register

Sixty two different replacement hip joints manufactured by 19 companies are currently available in Britain, half of which have been introduced in the past five years.1 A minimum follow up of 10 years is normally required to judge a joint replacement successful, but for only eight of these prostheses are there published follow ups of over five years. Only the Charnley low friction arthroplasty, widely regarded as the gold standard, has 20 year follow up results published in a peer reviewed journal.2 Since there is no requirement for new implants to be clinically tested before being introduced,3 the power of advertising, rather than a scientific report, may lead a surgeon to select one prosthesis in favour of another.”4 How then can we find out whether any implant is better than any other?