Search Results
Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for other papers by Anne Lübbeke in
Google Scholar
PubMed
Search for other papers by Christophe Combescure in
Google Scholar
PubMed
Search for other papers by Christophe Barea in
Google Scholar
PubMed
Search for other papers by Amanda Inez Gonzalez in
Google Scholar
PubMed
Search for other papers by Keith Tucker in
Google Scholar
PubMed
Search for other papers by Per Kjærsgaard-Andersen in
Google Scholar
PubMed
Search for other papers by Tom Melvin in
Google Scholar
PubMed
Search for other papers by Alan G Fraser in
Google Scholar
PubMed
Search for other papers by Rob Nelissen in
Google Scholar
PubMed
National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
Search for other papers by James A Smith in
Google Scholar
PubMed
Purpose
-
The objective of this systematic review was to give an overview of clinical investigations regarding hip and knee arthroplasty implants published in peer-reviewed scientific medical journals before entry into force of the EU Medical Device Regulation in May 2021.
Methods
-
We systematically reviewed the medical literature for a random selection of hip and knee implants to identify all peer-reviewed clinical investigations published within 10 years before and up to 20 years after regulatory approval. We report study characteristics, methodologies, outcomes, measures to prevent bias, and timing of clinical investigations of 30 current implants. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results
-
We identified 2912 publications and finally included 151 papers published between 1995 and 2021 (63 on hip stems, 34 on hip cups, and 54 on knee systems). We identified no clinical studies published before Conformité Européene (CE)-marking for any selected device, and no studies even up to 20 years after CE-marking in one-quarter of devices. There were very few randomized controlled trials, and registry-based studies generally had larger sample sizes and better methodology.
Conclusion
-
The peer-reviewed literature alone is insufficient as a source of clinical investigations of these high-risk devices intended for life-long use. A more systematic, efficient, and faster way to evaluate safety and performance is necessary. Using a phased introduction approach, nesting comparative studies of observational and experimental design in existing registries, increasing the use of benefit measures, and accelerating surrogate outcomes research will help to minimize risks and maximize benefits.
