3 Committee considerations

3 Committee considerations

The evidence

3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 8 sources, which was discussed by the committee. The evidence included 1 systematic review and network meta-analysis, 3 randomised controlled trials, 2 non-randomised comparative studies and 1 case series. The committee also considered safety data from 3 implant summary reports for the Profemur L Modular Stem, Profemur L Classic Stem and Procotyl L Cup, provided by the National Joint Registry. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

3.2 The professional experts and the committee considered the key efficacy outcomes to be: functional outcomes, quality of life and other patient-reported outcomes using validated measures.

3.3 The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection, fracture, dislocation, nerve palsy and leg length discrepancy.

3.4 Patient commentary was sought but none was received.

Committee comments

3.5 The committee was informed that, for this procedure:

  • suitable training and mentoring is needed

  • templating and planning should be used to ensure that leg length offset and intramedullary sizing are appropriate

  • mainly cementless implants are used, but other CE marked implants can be used

  • the safety profile differs depending on the type of implant

  • cementless implants might be associated with higher rates of intraoperative fractures.

3.6 The committee noted that this procedure appears to have short-term benefits, including early mobilisation.

ISBN: 978-1-4731-4597-9

  • National Institute for Health and Care Excellence (NICE)