ODEP supports the idea that procurement teams should be purchasing quality implants. ODEP also recognise that surgeons getting good results with a particular implant are unlikely to want to change and risk patients suffering from a “learning curve” with an implant with which they are unfamiliar.

It has also been brought to the attention of ODEP that a number of regulatory and purchasing agencies are discouraging surgeons from using products that have not received a 10A or 10A(*) rating, implying that 10A 10A(*) rated products perform better than other products.   This was never the intention of ODEP and is a misunderstanding and a misrepresentation of the philosophy of the system. Products with ratings at 3A(*), 5A(*), and 7A(*) are tracking to have outcomes in-line with a 10A(*)  13A(*)  and 15A* ratings.

• Some implants, with fewer years of data (3, 5 & 7 year data) may be tracking to have better outcome results than some existing 10A(*), 13A(*) or even 15A(*) rated products. Indeed, this may also be true of some products achieving a B rating. B ratings are usually assigned to boutique implants, where usage of these products has not normally been in large enough cohorts to command an A or and A* rating. B rated implants  would include specially designed implants for replacements, such as in DDH or where a developer is introducing a novel device extremely cautiously and not generating cohorts of patients big enough to command an A or A* rating
• It must be noted that B ratings are awarded after the same rigour as being applied to an A* rating cohort (except for the size of cohort and the number of surgeons and centres)
• “A” ratings are awarded where there are smaller cohort past the benchmark than for a * rating and therefore the confidence intervals are wider
• Pre-entry is not a benchmark it is simply an acknowledgement that the manufacturer has entered their product into the system
• Pre-Entry A* is classified as a benchmark for procurement purposes as it is being very closely monitored by the Beyond Compliance system.

An important principle that was embraced when ODEP was introduced, and remains today, is that the benchmarking system should not be designed to restrict the use of implants with less than 10 years of data.  Instead, the performance of all implants should be scrutinised at proscribed time points.  ODEP is not designed to deter innovation.