An Economic Analysis of Metal-on-Metal Versus Ceramic-on-Ceramic Hip Resurfacing: Costs and Clinical Implications.

Abstract

Background: Ceramic may be an alternative bearing surface that could be used to deal with the negative sequalae associated with the use of metal-on-metal (MoM) hip resurfacing implants, keeping the benefits of hip resurfacing without the risks. The aim of this study is to evaluate the additional financial and logistical implications that MoM hip resurfacing has, in comparison to its ceramic-on-ceramic (CoC) counterpart. Methods: Two different follow up protocols were analysed, according to current practice guidance, on how to follow up with hip resurfacing procedures. Reference costs were identified using the latest national cost collection data and data from the local biochemistry department. The results incorporated the number of hip resurfacings performed nationally. Results: The non-MoM protocol yielded a per operation lifetime follow up cost of £802.50, whereas the MoM protocol yielded a cost of £2132.83 at 25 years. Nationally, according to the 2023 data, this amounted to £561,750 versus £1,492,981 per year, respectively. MoM hip resurfacing is 2.6 times more expensive to be followed up with when compared to the standard protocol. Conclusion: The cost of the follow up of MoM bearings far exceeds that of non-MoM bearings. If CoC hip resurfacing is as clinically effective as MoM hip resurfacing, then the economics favour CoC bearing for resurfacing.