TY - JOUR

T1 - Low evidence for implementation of well- documented implants regarding risk of early revision

T2 - a systematic review on total hip arthroplasty

AU - Butler, Patrick

AU - Gorgis, Josef

AU - Viberg, Bjarke

AU - Overgaard, Søren

N1 - Publisher Copyright: © 2021. All rights reserved.

PY - 2021

Y1 - 2021

N2 - » When introducing an implant, surgeons are subjected to steep learning curves, which may lead to a heightened revision rate. Stepwise introduction revolutionized implant introduction but lacks a last step. » No guidelines exist for the introduction of a well-documented implant not previously used in a department. This is problematic according to the European Union’s legislated tendering process, potentially leading to increased revisions. In this systematic review, the introduction of a well-documented total hip arthroplasty implant to experienced surgeons is explored amid concerns of higher revision rate. » Literature search strategies were deployed in the Embase and Medline databases, revealing a total of 14,612 articles. Using the Covidence software (Cochrane, London), two reviewers screened articles for inclusion. » No articles were found that fulfilled our eligibility criteria. A post hoc analysis retrieved two national register-based studies only missing information about the surgeon’s knowledge of the introduced implant. None of the introduced implants decreased the revision rate and around 30% of the introduced implants were associated with a higher revision rate. » The review showed that no data exist about revision rates when introducing well-documented implants. In continuation thereof, the introduction of well-documented implants might also be associated with increased revision rates, as has been shown for total knee arthroplasty. We therefore suggest that special attention should be focused on changes of implants in departments, which can be achieved by way of specific registration in national registers.

AB - » When introducing an implant, surgeons are subjected to steep learning curves, which may lead to a heightened revision rate. Stepwise introduction revolutionized implant introduction but lacks a last step. » No guidelines exist for the introduction of a well-documented implant not previously used in a department. This is problematic according to the European Union’s legislated tendering process, potentially leading to increased revisions. In this systematic review, the introduction of a well-documented total hip arthroplasty implant to experienced surgeons is explored amid concerns of higher revision rate. » Literature search strategies were deployed in the Embase and Medline databases, revealing a total of 14,612 articles. Using the Covidence software (Cochrane, London), two reviewers screened articles for inclusion. » No articles were found that fulfilled our eligibility criteria. A post hoc analysis retrieved two national register-based studies only missing information about the surgeon’s knowledge of the introduced implant. None of the introduced implants decreased the revision rate and around 30% of the introduced implants were associated with a higher revision rate. » The review showed that no data exist about revision rates when introducing well-documented implants. In continuation thereof, the introduction of well-documented implants might also be associated with increased revision rates, as has been shown for total knee arthroplasty. We therefore suggest that special attention should be focused on changes of implants in departments, which can be achieved by way of specific registration in national registers.

KW - experienced surgeons

KW - implementation

KW - learning curve

KW - systematic review

KW - total hip arthroplasty

KW - well-documented implants

U2 - 10.1302/2058-5241.6.200047

DO - 10.1302/2058-5241.6.200047

M3 - Review

C2 - 33542834

AN - SCOPUS:85100420382

VL - 6

SP - 3

EP - 8

JO - EFORT Open Reviews

JF - EFORT Open Reviews

SN - 2396-7544

IS - 1

ER -