Patient survival matters as much as implant survival when selecting the right hip replacement

Clearly, cemented implants performed better (lasted longer) in patients aged over 65 years,” according to Hamilton and Howie and the Nordic registry.1 2 But the “clear” superiority reported was actually a 1% difference at 10 years (94% v 93%).

Although this difference may be statistically significant, it is hardly clinically relevant. For patients and surgeons, the patient’s mortality is perhaps of greater relevance. The use of statistics on prosthesis “survival” when the patients’ survival is ignored is worrying.3 The mortality rate in this patient group is substantially in excess of the revision rate. Mortality may even be influenced by the prosthesis used, as reported in the BMJ last year with regard to hip resurfacing.4