International Journal of Technology Assessment in Health Care


José M.  Quintana a1, Jesús  Azkarate a2, J. Ignacio  Goenaga a3, Inmaculada  Aróstegui a4, Ignacio  Beldarrain a5 and Jose M.  Villar a6
a1 Hospital de Galdakao
a2 Hospital del Bajo Deba
a3 Hospital de Santiago
a4 Universidad del País Vasco
a5 Hospital de Aránzazu
a6 Hospital de Crúces


Objective: To evaluate the appropriateness of the use of hip joint replacements (HJRs) using explicit criteria developed by an expert panel.

Methods: Observational study. Nine hundred ninety-seven patients from five hospitals with a diagnosis of osteoarthritis, avascular necrosis, hip fracture, or revision who were undergoing HJR were consecutively included in the study during a 1-year period. The appropriateness of the indication was judged by explicit criteria. Complications were recorded at the time of the intervention and 3 months postoperatively.

Results: Of the 1,030 interventions, 604 were for osteoarthritis, 31 avascular necrosis, 191 fractures, and 204 revisions. No differences were found among the hospitals for the main clinical and patient variables. Indications for surgery were considered appropriate in 59% of cases, uncertain in 32%, and inappropriate in 8%, mainly in the osteoarthritis group. Differences were found in the rates of appropriateness among some centers. The complication rate did not differ among the groups based on the level of appropriateness of the procedure.

Conclusions: The appropriate use of HJR, as measured by the criteria established by the panel, identified a moderate percentage of inappropriate indications. Those equivocal and inappropriate cases demand further studies to identify patients with an adequate risk-to-benefit ratio from this procedure.

Key Words: Hip prosthesis; appropriateness; Utilization review.