AN OUTCOME ANALYSIS OF THE INTRACAPSULAR PROXIMAL FEMORAL FRACTURE PATIENTS CONSIDERED TO BE POTENTIAL CANDIDATES FOR PRIMARY TOTAL HIP ARTHROPLASTY

Abstract

This study aims to determine, by outcome analysis, the appropriateness of current criteria employed to select patients for total hip arthroplasty (THA) as the primary treatment for displaced intracapsular hip fracture (DICHF) and to inform prospective randomised controlled trials investigating the efficacy of THA as a primary treatment.

Contemporary THA eligibility criteria were derived from recent publications relating to pre-fracture residence, mobility and independence. Outcome data were analysed for 96 patients (19% of 506 consecutive patients with DICHF between 2003–2005) who fulfilled those criteria. The variables analysed included age, gender, co-existing injuries, co-morbidities, social circumstances, mobility, independence, delay to surgery, readmission, and death. Patients were followed for three years. The primary outcome was the combined achievement of home or warden-assisted accommodation at three months, no re-admission within 6 weeks and survival to 1 year. Secondary outcome was survival to three years.

At 3-months 86 patients (90%) had returned home, three (3.1%) required nursing or residential home placement, four (4.2%) were still resident in a community hospital, and three (3.1%) had died. Eight patients (8.3%) were re-admitted within 6-weeks. Mortality was 8.3% at 1-year and 25% at 3-years. Patients not achieving return to home were older (84.8 years vs. 79.7 years, p=0.19), were more likely to use a walking aid (OR 2.35) or required home support (OR 1.74) prior to fracture. The number of co-morbidities was not an association. Backward selection identified age as a significant variable in patients successfully discharged home (OR 1.12, CI 1.01 – 1.21).

If maintaining a high level of activity and independence is the expectation for hip fracture patients considered for THA then current selection criteria appear appropriate in identifying those 15% capable of returning home, remaining independent and surviving to one year.