INTRODUCTION: The National Institute for Health and Care Excellence (NICE) currently recommends the use of total hip replacement (THR) for displaced intracapsular hip fractures in patients who meet certain mobility, cognitive and health criteria. METHODS: A multicentre prospective audit was conducted within a defined geographic region to assess current practice and variation in provision of THR for displaced intracapsular hip fractures. RESULTS: A total of 879 patients with hip fractures, admitted to 8 acute trauma units, were included in this study. Of 462 patients with displaced intracapsular hip fractures, 169 fulfilled the NICE criteria for THR. THR was performed for only 49 of (29%) the eligible patients. There was significant variation in THR provision between the eight units (0% to 50% THR usage, p<0.001). There were statistically significant differences in age, ASA (American Society of Anesthesiologists) grade, abbreviated mental test score and walking ability prior to the injury between patients who underwent fixation, THR or hemiarthroplasty (all p≤0.05). There was a significantly increased chance of not undergoing THR if a patient was older than 77 years (median age for the THR eligible cohort; relative risk [RR]: 7.9, 95% confidence interval [CI]: 2.8-22.0, p<0.001). There was also a trend for this with patients who were ASA grade 3 compared with ASA grade 1 or 2 (RR: 2.7, 95% CI: 1.0-7.3, p=0.06). The surgeons gave multifactorial reasons for not performing THR in eligible patients. CONCLUSIONS: There is significant variation in the provision of THR for eligible hip fracture patients, which is influenced by both patient demographics and the unit to which a patient is admitted.
INTRODUCTION: The National Institute for Health and Care Excellence (NICE) currently recommends the use of total hip replacement (THR) for displaced intracapsular hip fractures in patients who meet certain mobility, cognitive and health criteria. METHODS: A multicentre prospective audit was conducted within a defined geographic region to assess current practice and variation in provision of THR for displaced intracapsular hip fractures. RESULTS: A total of 879 patients with hip fractures, admitted to 8 acute trauma units, were included in this study. Of 462 patients with displaced intracapsular hip fractures, 169 fulfilled the NICE criteria for THR. THR was performed for only 49 of (29%) the eligible patients. There was significant variation in THR provision between the eight units (0% to 50% THR usage, p<0.001). There were statistically significant differences in age, ASA (American Society of Anesthesiologists) grade, abbreviated mental test score and walking ability prior to the injury between patients who underwent fixation, THR or hemiarthroplasty (all p≤0.05). There was a significantly increased chance of not undergoing THR if a patient was older than 77 years (median age for the THR eligible cohort; relative risk [RR]: 7.9, 95% confidence interval [CI]: 2.8-22.0, p<0.001). There was also a trend for this with patients who were ASA grade 3 compared with ASA grade 1 or 2 (RR: 2.7, 95% CI: 1.0-7.3, p=0.06). The surgeons gave multifactorial reasons for not performing THR in eligible patients. CONCLUSIONS: There is significant variation in the provision of THR for eligible hip fracturepatients, which is influenced by both patient demographics and the unit to which a patient is admitted.
Entities:
Keywords:
Arthroplasty; Hip fracture; Physician’s practice patterns; Replacement
Authors: Paul T P W Burgers; Arnoud R Van Geene; Michel P J Van den Bekerom; Esther M M Van Lieshout; Bastiaan Blom; Ilyas S Aleem; M Bhandari; Rudolf W Poolman Journal: Int Orthop Date: 2012-05-24 Impact factor: 3.075
Authors: Michel P J van den Bekerom; Inger N Sierevelt; Harmjan Bonke; Ernst L F B Raaymakers Journal: Acta Orthop Date: 2013-11-29 Impact factor: 3.717