Total hip replacement in patients with hip fracture

Abstract

There is increasing interest in the use of total hip replacement (THR) for reconstruction in patients who have displaced intracapsular hip fractures. Patient selection is important for good outcomes, but criteria have only recently been clearly defined in the form of national guidelines. This study aimed to investigate patient reported outcomes and satisfaction after THR undertaken for displaced hip fractures and to compare these with a matched cohort of patients undergoing contemporaneous THR for osteoarthritis to assess the safety and effectiveness of national clinical guidelines. One hundred patients were selected for treatment of displaced hip fractures using THR between January 1, 2007, and December 31, 2009. These patients were selected using national guidelines and were matched for age and sex with 300 patients who underwent contemporaneous THR as an elective procedure for osteoarthritis. Patients undergoing THR for both fracture and as an elective procedure reported excellent outcomes and satisfaction. Patients with hip fracture had better postoperative Oxford hip scores (p < 0.001) and SF-12 physical component scores (p < 0.001). Mental component scores were poorer for patients with hip fracture (p < 0.001). In this series, the rates of major complications for patients with hip fracture were higher than for elective patients. For patients with hip fracture, the rate of dislocation was 2%, the rate of deep infection was 3%, and early revision operation was required for 2% of patients. The 30-day mortality for patients with hip fracture was zero. Nevertheless, these complication rates are similar to those widely reported in the literature and considered within acceptable limits after elective operation. For selected patients, THR undertaken for displaced fractures of the hip produces outcomes that are at least equivalent to those achieved after elective operation. Selection is critical to this success, and the extended use of current guidelines is appropriate and safe. Therapeutic study, level IV.