An analysis of outcomes data found that there is little to no support for new joint replacements in comparison to their predecessors.
In fact, the study in the BMJ reports that the 5-year revision rate for hip replacements with modular femoral necks is higher than in older implants with nonmodular necks (7.4% to 3.7% respectively). And audible squeaking and implant fracture also occurred more often in hip replacements with ceramic-on-ceramic bearings, the authors said.
The authors report that previous studies also failed to find benefits from uncemented monoblock acetabular cups in comparison to earlier hip replacements. Regarding knee implants, an Australian registry reported a 10-year revision rate of 5.6% for high-flexion versions, compared to 4.6% in standard devices, according to the paper's overview of the evidence.
"Our goals are to highlight that the status quo regarding the introduction of new device technologies is not acceptable, that substantial efforts are needed by all stakeholders to invest in systems of careful evaluation, and to promote controlled and evidence-based introduction of device innovations," the authors wrote, according to MedPage Today.
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| Stryker knee replacement--Courtesy of Stryker |
To communicate these findings to patients and help them make better choices, two Harvard academics recommended in a supplementary editorial "plainly worded drug facts boxes that provide summaries of a product's supporting evidence." They also called for compulsory enrollment in device registries.
Efforts are underway on both fronts already. The FDA is testing standardized device labeling, and advocates from the Pew Research Center and other organizations are pushing for the use of joint registries.
Todd Ebert, CEO of the group purchasing organization Amerinet, previously told FierceMedicalDevices that a lack of product differentiation and technological advances in the orthopedics industry is partly responsible for implants' declining prices, saying, "when you talk to the clinicians that know these things, they're saying that there's not a whole lot of difference between these things."
- read about the study in MedPage Today