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Updated: May 13, 2026

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Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis.

Mark Pennington1, Richard Grieve, Jasjeet S Sekhon

  • 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK. mark.pennington@lshtm.ac.uk

BMJ (Clinical Research Ed.)
|March 1, 2013
PubMed
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For total hip replacement, cemented prostheses are cheapest, but hybrid prostheses offer the best value. Cementless options do not justify their higher cost with improved health outcomes.

Area of Science:

  • Orthopedic surgery
  • Health economics
  • Biomaterials science

Background:

  • Total hip replacement (THR) is a common procedure for osteoarthritis.
  • Prosthesis selection impacts long-term patient outcomes and healthcare costs.
  • Three main types of THR prostheses exist: cemented, cementless, and hybrid.

Purpose of the Study:

  • To compare the cost-effectiveness of cemented, cementless, and hybrid prostheses for primary total hip replacement.
  • To identify the most cost-effective prosthesis type across different patient demographics.

Main Methods:

  • A lifetime cost-effectiveness model was developed.
  • Parameters were estimated using individual patient data from three large national databases.
  • Analysis focused on patients aged 55-84 undergoing THR for osteoarthritis within the English National Health Service.

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Main Results:

  • Cemented prostheses demonstrated the lowest lifetime costs.
  • Hybrid prostheses yielded the highest postoperative quality of life and lifetime Quality-Adjusted Life Years (QALYs).
  • Hybrid prostheses were most cost-effective for most patient groups, with an incremental cost of £2500 per QALY compared to cemented prostheses.

Conclusions:

  • While cemented prostheses are the least expensive, hybrid prostheses represent the most cost-effective option for the majority of patients.
  • Cementless prostheses did not offer sufficient health outcome improvements to warrant their increased cost.
  • Prosthesis choice significantly influences long-term healthcare expenditure and patient quality of life.