Total hip and knee replacements: a survey of 261 hospitals in England

A survey of all 261 National Health Service hospitals in the 14 regions of England performing joint replacement surgery was carried out to determine inter-regional variations in the surgeon's choice of hip and knee replacements. There are over 30 types of cemented, 35 types of uncemented hip replacements, and more than 35 types of knee prostheses for the surgeon to choose from. The Charnley low friction arthroplasty is the market leader in hip surgery and is used in 193 hospitals (74%). There is a marked North-South divide in the use of this prosthesis. The Kinematic and Insall Burstein prostheses are the most popular knee replacements. At present, there is a huge choice of joint replacement on the market and many implants have yet to prove that they offer any real advantages over established and often cheaper alternatives. It is suggested that special centres for joint replacement surgery within each region should run clinical trials to determine which prostheses have the best long-term results. The resulting standardization of implants within each hospital would enable Regional Health Authorities to reduce costs in the short-term by cutting stock levels, and should reduce costs in the long-term by reducing the revision rate of failed joint replacements.