Patient Reported Outcome Measures ( PROMs ) at six months have been investigated but have not been vali date d against long-term outcomes .
EBRA can be used to investigate acetabular wear but not femoral migration .
OBJECTIVES High failure rates of metal-on-metal hip arthroplasty implants  have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices .
The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage .
We aim ed to identify vali date d surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty ( THA ) .
IDEAL framework for surgical innovation 3: randomised controlled trials in the assessment stage and evaluations in the long term study stage
The complexity of surgical procedures often poses challenges for conducting a rigorous and comprehensive evaluation . This paper considers the final two IDEAL stages of surgical innovation . Surgical r and omised controlled trials are often challenging to undertake and require careful consideration of the intervention definition , who should deliver it , and the impact of surgeon and patient preferences . In the long term study stage , better monitoring of surgical procedures is needed , along with improved surveillance of devices
Patient Reported Outcome Measures ( PROMs ) at six months have been investigated but have not been vali date d against long-term outcomes .
EBRA can be used to investigate acetabular wear but not femoral migration .
OBJECTIVES High failure rates of metal-on-metal hip arthroplasty implants  have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices .
The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage .
We aim ed to identify vali date d surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty ( THA ) .