UNCEMENTED HIP REPLACEMENTS HAVE SIGNIFICANT ECONOMIC BENEFITS OVER CEMENTED HIPS

Abstract

Aim: To evaluate the possible increase to surgical/operating room capacity by increasing the percentage of uncemented total hip replacement

Introduction: Globally there is growing demand for increased efficiency and productivity from medical care. In hip arthroplasty there has been increased interest in the use of uncemented components with several studies and registry data showing them to perform well clinically 1, 2. One concern with their increased use has been increased costs 3. We have examined the issue of operative timing and discuss the possible role these components may have in increasing theatre utilisation times and so offsetting their cost.

Methods: This was a prospective, cohort study of every hip replacement performed in a dedicated arthroplasty unit within a district general hospital over one year. All care of patients was standardised using pathways, including all surgeons using a posterior approach with posterior repair. This allowed us to determine the relative effect of prosthesis type on quality, safety and efficiency. Demographic, anaesthetic, operative and timing details on all cases performed were collected prospectively and independently of the surgical team. Patients were reviewed at six weeks and one year post op. All readmissions to any hospital were noted and any further surgery recorded.

Results: There were 1248 cases performed in one year. Of these 194 were uncemented (both components) and 286 cemented total hip replacements. Patient demographics were similar (mean age 70.9 years, range 28–92). Both hip types showed no difference in quality or safety factors as assessed by hip scores, patient mobilisation times, complication rates or revision rates. The only difference was in the surgical times. These were (in minutes):

• – Mean Standard Deviation Minimum Maximum

• – Uncemented 49 * 14 25 122

• – Cemented 66 12 42 122

(*p< 0.0005)

Conclusions: Our data demonstrates an average time saving of 17 minutes per case performed. If, over the next year, we converted to all uncemented hips we would release 136 hours of operative time, giving an opportunity to get 100 more cases done. This represents a 20% increase in productivity with no compromise to safety or quality.