Year published: 2012
Total hip replacement and resurfacing arthroplasty for the treatment of pain or disability resulting from end stage arthritis of the hip (Review of technology appraisal guidance 2 and 44)
http://www.nice.org.uk/guidance/TA304
Dear Consultees and Commentators,
At the Consultee information Meeting (CIM) held for this MTA on 11 December, it became clear that in order to allow the aims of the review to be fully met, some elements of the scope need to be clarified.
The Assessment Group and consultees attending the workshop agreed that the following amendments to the scope would be useful:
1. Patient population:
At the CIM it became clear that the word ‘end stage’ is interpreted differently by different people, and the evidence would probably not offer this level of detail in order to be able to identify the population of concern on this basis. In any case, the first decision point in a patient’s pathway at which total hip replacement or resurfacing is considered (and therefore the point at which an appraisal of these technologies becomes relevant) is when non-surgical management is no longer an option, therefore this has been used as definition of the population. An explanatory sentence has been added to the scope.
2. Comparisons to be made
At the CIM it became clear that it needs to be made explicit that the phrase ‘Primary total hip replacement ‘encompasses a large number of individual types of prostheses which vary by bearing material, fixation methods, femoral head size, and by revision rate, and that these will be compared with each other, depending on the evidence available. Following discussions on the definition of the population (see above) it was further clarified that non surgical management is not an appropriate comparator for the population of concern in this appraisal. Therefore this has been removed from the comparators.
It was also stated at the CIM that hip resurfacing arthroplasty is only used for a small and very defined patient population but that it is still relevant to compare methods for primary total hip replacement with hip resurfacing arthroplasty in this population.
In addition it was agreed that there is potentially very large numbers of types of primary total hip replacement because of the combination of different materials, fixation methods and femoral head sizes. It was clarified at the CIM that a limited number of categories/ types of hips prostheses will be used in the analyses informed by the evidence, mainly the NJR.
Please find attached an updated final scope reflecting these amendments.
If you have any questions, please let me know.
Kind regards,
Jeremy
Jeremy Powell
Technology Appraisal Project Manager
National Institute for Health and Clinical Excellence
10 Spring Gardens | London SW1A 2BU | United Kingdom
Tel: 44 (0)20 7045 2248 | Fax: 44 (0)20 7061 9830