November 21, 2013 NICE draft guidance update on hip replacement and resurfacing recommends more reliable artificial joints NICE is updating its guidance on providing people who need hip replacements with the right prosthesis for their requirements. The updated draft recommendations include a stricter benchmark for the quality of hip prostheses, proposing that the new joint should work well in at least 95% of cases over 10 years, instead of the current 90% of cases. Hip replacements or resurfacing are often needed to improve mobility problems and severe discomfort caused by rheumatoid arthritis or osteoarthritis in the hip joint. Arthritis is a very common and painful condition – it affects more than 3 million people in the UK. Someone with arthritis can experience significant pain and stiffness which will limit everyday tasks such as walking, climbing stairs and performing household tasks. However, a successful hip replacement can completely relieve pain and disability associated with arthritis of the hip when exercise, physiotherapy or medicines no longer work. Around 60,000 operations to replace hips are carried out in the NHS in England and Wales each year with a further 25,000 carried out in independent hospitals. Nevertheless, sometimes wear or other problems with the artificial joint mean that it has to be replaced. This replacement is called a ‘revision’. Commenting on the draft guidance, Professor Carole Longson, Director of the Centre for Health Technology Evaluation at NICE said: “This new draft guidance for those with arthritis of the hip who have already tried non-surgical treatments such as exercise, physical therapy or painkillers, will help ensure they receive the best possible prosthesis for them.” “Importantly, as we now have more information about how long artificial joints can last, we have recommended the use of prostheses with a proven lower revision rate. This means that a new joint should work well in at least 95% of cases over 10 years, so a revision may be needed in 5% or fewer cases over this period. Our existing guidance advises that prostheses should work well in at least 90% of cases, so repeat surgery may be needed in up to 10% of cases over 10 years. The proposed improvement to the benchmark for the revision rate is good news for people with hip replacements or hips resurfacing – more people can expect their prostheses to continue working well over 10 years.” This new appraisal reviews previous NICE guidance on total hip replacement and metal hip resurfacing. Since the original recommendations were published, more information has become available on how often the artificial hip joints and resurfacing would need to be replaced or the ‘revision rate’. Current NICE guidance recommends a revision rate of 1 in 10 (10%) after 10 years as a ‘benchmark’ in the selection of artificial joints. The new draft guidance recommends a rate (or projected rate) of revision of less than 1 in 20 (5%) after 10 years. What type of hip replacement prostheses a patient receives depends on various factors, such as a patient’s age and underlying hip physiology, as well as the surgeon’s choice and experience of using a particular class of prosthesis. Consultees, including the manufacturers, healthcare professionals and members of the public are now able to comment on the preliminary recommendations which are available for public consultation. Comments received during this consultation will be fully considered by the Committee and following this meeting the next draft guidance will be issued.