Draw up guidelines with recommendations on the use of different kinds of hip prosthesis and their cost, comparing this with current clinical practice.
Medium to large hospitals in the Osakidetza network. The working team included traumatologists, rehabilitators, rheumatologists, epidemiologists and experts in cost analysis and biostatistics.
Patients who had been fitted with a total hip prosthesis in 1997.
Review of the bibliography on this subject, summarising the scientific evidence. Application of algorithms based on the appropriate use developed by the RAND method. Gathering of data on clinical practice. With the information collected from the above sources, an analysis was made, results were presented to the team and the panel of experts and the conclusions of the study were published.
A total of 831 operations were performed, of which 136 were cemented (16%), 639 non cemented (77%) and there were 56 hybrids (7%). The use of two thirds of the cemented prostheses were considered by the panel of experts to be appropriate (92) and in the rest of the cases, the operation was considered to be doubtful, and the use of a non cemented prosthesis was proposed. According to the panel, the majority of non cemented prostheses were considered to be appropriate (94%) and the rest (6%) were considered to be doubtful and the technique proposed was the opposite one, i.e., cemented prosthesis. In all operations of hybrid fastening, the panel considered the suitability of this operation to be doubtful. Finally, in the majority (85%) of the 68 cases of acetabular replacement in which the cemented prosthesis was used (34%), the non cemented prosthesis was suggested. However, when the technique used was the non cemented prosthesis (66%), the majority of these (94%) were considered to be appropriate. The cases of femoral replacement were similar.
There is a great deficiency in the number and quality of studies assessing the efficiency, effectiveness and cost of the different fixing mechanisms used in hip prosthesis operations. One of the recommendations of this panel of experts is to create a system of registration of all the operations financed by the public health service in which articular prosthesis are used.