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We have also found variations in practice between NHS trusts and between orthopaedic consultants on a range of issues such as the purchase of hip prostheses, supervision of surgery, length of patient stay in hospital, and follow-up after operation. In the light of these findings, based in part on major surveys of orthopaedic consultants and NHS trusts, Sir John makes 20 recommendations for improving the service provided to patients who require total hip replacements. Most patients requiring a hip replacement receive an excellent service from the NHS. However, there are over 60 different hip prostheses available, and evidence of long term effectiveness is not available for all those in current use. Most patients are implanted with one of a small number of established designs and can expect their new hip to work effectively for some ten to fifteen years. In these and other areas, all trusts and consultants need to follow good practice for the benefit of patients. In particular: the NHS Executive and the Medical Devices Agency should take further action to ensure the effectiveness of new hip prostheses. However, the current process for introducing new hip prostheses into the NHS cannot always ensure long term effectiveness, and if a hip prosthesis performs poorly, it can have serious consequences for the patient. Sector s : Health and social care.

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