A systematic review 1 including 191 studies (11 RCTs and 180 observational studies) was abstracted in DARE. The two largest observational studies showed that Charnley prosthesis performed more favourably than other prostheses. The other 16 comparative studies were of much smaller size. Eight of these included Charnley, and all except one study showed the Charnley as performing more favourably than the comparison prostheses. The most favourable revision rates (per 100 person years at risk) were found for the Exeter (0.18), Lubinus (0.27) and Charnley (0.37). No evidence was found favouring cementless prostheses.
A Norwegian technology assessment report 2 on hip replacement therapy was abstracted in the Health Technology Assessment Database. Approximately 1/3 of the prostheses used in Norway in the year 2000 lacked scientific documentation. Six cemented prostheses (Charnley, Exeter, ITH, Lubinus, Spectron and Titan) have a documented 90% survival after at least 10 years of follow-up (year 2000). Charnley and Lubinus have over 15 years documented follow-up. None of the cementless total prostheses used in Norway in 2000 met the criteria of 90% or greater documented survival after 10 years. Results from the Norwegian and Swedish register studies indicate that Palacos and Simplex cements are better than CMW and Sulfix cements.
Comment: The evidence is mostly based on observational studies. The model of the Charnley prosthesis has changed, and there is a possibility that the presented evidence cannot be applied to the present model.
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