A REGIONAL AUDIT ON THE PROVISION OF TOTAL HIP REPLACEMENT FOR DISPLACED INTRACAPSULAR HIP FRACTURES

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 cognitively competent patients and who were independently mobile with the maximum use of one stick prior to the injury. Method We conducted a prospective cross sectional study of the management of hip fractures within a defined geographic region in the North East of England to assess current practice and variation in provision of THR for displaced intracapsular hip fracture. Results A total of 879 patients with hip fracture, admitted to eight acute trauma units were included in this study. 169 of 462 patients with displaced intracapsular hip fractures fulfilled the NICE criteria for THR. THR was performed for only 49 of the eligible patients (29%). There was significant variation in THR provision between the eight units (0% THR usage to 50% usage) (p<0.001). In the patients with a displaced intracapsular fracture, there were statistically significant differences in the age, ASA grade, AMTS and pre-injury walking ability between patients who underwent fixation, THR or hemiarthroplasty (all p≤0.05). There was an increased chance of undergoing THR if a patient was 77 years (the median age for the THR eligible cohort) or younger compared to older than 77 years (RR=7.9, 95%CI 2.8–22.0, p<0.001) and if the patients were either ASA grade 1 or 2 compared to ASA grade 3 (RR=2.7, 95%CI 1.0–7.3, p=0.06). The reasons given by the treating surgeon for not performing THR in eligible patients were multifactorial. Conclusion There is significant variation in the provision of THR for eligible hip fracture patients which is influenced by both patient demographics and also by the unit to which the patient is admitted.