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Total Hip Replacement
NIH Consensus Development Panel on Total Hip Replacement;
David G. Murray, MD;
Renée S. Crown;
Kay Dickersin, PhD;
Pamela Woods Duncan, PhD, PT;
Charles H. Epps, Jr, MD;
Walter H. Ettinger, Jr, MD;
Gary E. Friedlaender, MD;
Joseph M. Lane, MD;
Jack E. Lemons, PhD;
Jack L. Lewis, PhD;
Ellen J. MacKenzie, PhD;
Robert S. Pinals, MD;
Paul S. Treuhaft, MD;
J. Dennis Bobyn, PhD;
John J. Callaghan, MD;
William N. Capello, MD;
Jane A. Cauley, DrPH;
Dwight T. Davy, PhD;
J. Robin deAndrade, MD, FRCS (Eng & C);
Charles A. Engh, MD;
Robert H. Fitzgerald, Jr, MD;
Jorge O. Galante, MD;
Jeremy L. Gilbert, PhD;
Victor M. Goldberg, MD;
Steven R. Goldring, MD;
William H. Harris, MD;
Peter Herberts, MD, PhD;
David S. Hungerford, MD;
Joshua J. Jacobs, MD;
Murali Jasty, MD;
Norman A. Johanson, MD;
David G. Lewallen, MD;
William J. Maloney, MD;
Harry E. Rubash, MD;
Eduardo A. Salvati, MD;
Clement B. Sledge, MD;
Dale R. Sumner, PhD;
Hans G. Willert, MD;
Timothy M. Wright, PhD;
Stephen Gordon, PhD;
Daniel J. Chwirut, MS;
Chhanda Dutta, PhD;
Jerry M. Elliott;
John H. Ferguson, MD;
Jorge O. Galante, MD;
William H. Hall;
Richard C. Johnston, MD;
Daniel S. McGunagle;
David G. Murray, MD;
Louis A. Quatrano, PhD;
Judith S. Wortman;
Timothy M. Wright, PhD;
Lawrence E. Shulman, MD, PhD;
John H. Ferguson, MD;
Richard J. Hodes, MD;
Duane F. Alexander, MD;
Vivian W. Pinn, MD
JAMA. 1995;273(24):1950-1956.
Abstract
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Objective.
—To provide physicians with a current consensus on total hip replacement.
Participants.
—A nonfederal, nonadvocate, 13-member consensus panel representing the fields of orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, internal medicine, public health, geriatrics, biostatistics, and a public representative. In addition, 27 experts in orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, rheumatology, geriatrics, and epidemiology presented data to the consensus panel and a conference audience of 425.
Evidence.
—The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.
Consensus.
—The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.
Consensus Statement.
—The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.
Conclusions.
—Total hip replacement is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment. Most patients have an excellent prognosis for long-term improvement in symptoms and physical function. At this time, a cemented femoral component using modern cementing techniques, paired with a porous-coated acetabular component, can give excellent long-term results. Revision of a total hip replacement is indicated when mechanical failure occurs. Continued periodic follow-up is necessary to identify early evidence of impending failure so as to permit remedial action before a catastrophic event.
(JAMA. 1995;273:1950-1956)
Author Affiliations
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Panel and Conference Chairperson, Professor and Chairman, Department of Orthopedic Surgery, State University of New York Health Sciences Center, Syracuse; Wilmette, III; Assistant Professor, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore; Director of Research, Center for Aging, Kansas University Medical Center, Kansas City; Vice President, Health Affairs, Howard University, Washington, DC; Professor of Internal Medicine and Public Health Sciences, Department of Internal Medicine, Bowman Gray School of Medicine, Winston-Salem, NC; Professor and Chairman, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Conn; Professor and Chairman, Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, Calif; Professor, Departments of Biomaterials and Surgery, Division of Orthopaedic Surgery, University of Alabama at Birmingham; Professor, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis; Professor, Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md; Professor, Department of Medicine/Rheumatology, The Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Department of Medicine, Medical Center at Princeton; Orthopaedic Surgeon, Kolczun and Kolczun Orthopaedic Associates, Lorain, Ohio; "Total Hip Replacement: Femoral Fixation"; "Prophylaxis for Deep Venous Thrombosis and Infection and Acetabular Preparation"; "Outcomes With Special Devices"; "Epidemiology of Total Hip Replacement"; "Joint Loads in Total Hip Arthroplasty"; "Selected Issues in Postsurgical Management and Rehabilitation Following Total Hip Replacement"; "Cementless Total Hip Arthroplasty Outcomes: Extensively Porous-Coated Implants"; "Management of the Patient With an Infected Total Hip Replacement"; "Acetabular Revision"; "Degradation in Modular Femoral Hip Prosthesis Tapers"; "Technical Aspects of Inserting Cementless Femoral Components"; "Local and Systemic Response to Wear Particles: Immune and Cellular Responses of Bone and Connective Tissues"; "Femoral Cementing Techniques"; "Indications for Revision of a Total Hip Replacement: Factors of Importance for Failures and Overview of Outcomes"; "Clinical Experience and Current Status of Proximally Coated Cementless Femoral Stems"; "Particulate Wear"; "Acetabular Fixation"; "Principles of Outcomes Measures"; "Femoral Revisions: Cementless"; "Cemented Outcomes: Modern Techniques" Cecil H. Rorabeck, MD, FRCS(C), "Cost-Benefit Assessment of Total Hip Replacement"; "Revision of the Femoral Component Using Cement"; "Outcomes of Cemented Total Hip Replacement of the First Generation"; "Total Hip Replacement: Twelve Years Later—What Has Changed?"; "Local Bone Remodeling: Animal, Human, and Mathematical and Analytic Results"; "Overview of Long-Term Interface Response"; "Polyethylene"; Chairperson, Chief, Musculoskeletal Diseases Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md; Mechanical Engineer, Division of Mechanics and Materials Science, Food and Drug Administration, Rockville, Md; Director of Musculoskeletal Research, Geriatrics Program, National Institute on Aging, National Institutes of Health, Bethesda, Md; Program Analyst, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Director, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Professor of Orthopedic Surgery, The Grainger Director, Rush Arthritis and Orthopedics Institute, Rush-Presbyterian-St. Luke's Medical Center, Chicago, III; Director of Communications, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Clinical Professor of Orthopedics, University of Iowa, Des Moines (Iowa) Orthopedic Surgeons; Chief, Orthopedic Devices Branch, Food and Drug Administration, Rockville, Md; Panel and Conference Chairperson, Professor and Chairman, Department of Orthopedic Surgery, State University of New York Health Sciences Center, Syracuse; Chief, Applied Rehabilitation Medicine Research Branch, National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md; Technical Information Specialist, Office of Scientific and Health Communications, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md; Director, Department of Biomechanics, The Hospital for Special Surgery, New York, NY; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Medical Applications of Research; National Institute on Aging; National Institute of Child Health and Human Development; Office of Research on Women's Health
Footnotes
NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to a biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.
NIH Consensus Statements are prepared by a nonadvocate, nonfederal panel of experts, based on (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third day. This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government.
Preparation and distribution of this statement is the responsibility of the Office of Medical Applications of Research of the National Institutes of Health. Free copies of this statement and bibliographies prepared by the National Library of Medicine are available from the Office of Medical Applications of Research, Federal Bldg, Room 618, National Institutes of Health, 7550 Wisconsin Ave MSC 9120, Bethesda, MD 20892 (William H. Hail) or the NIH Consensus Program Information Service by 24-hour voice mail at (800) NIH-OMAR (644-6627).
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