A longer stay in the hospital after primary total hip replacement is consistent with an increased morbidity and slower recovery for patients. In addition, it is among the more costly aspects of a total joint replacement. A process, which reduces the length of stay following this procedure and synchronically maintains the high standards of safe care would certainly improve the clinical practice and provide financial benefits.

Our objective was to evaluate the efficiency of a holistic perioperative, accelerated recovery programme following this procedure and in particular to assess its impact in the shot term patient’s recovery, morbidity, complications, readmission rate and cost savings for the NHS.

Eighty-nine patients participated in our rapid recovery programme, which is a comprehensive approach to patient care, combining individual pre-operative patient education, pain management, infection control, continuous nursing and medical staff motivation as well as intensive physiotherapy in the ward and the community. Forty-eight male and 41 female patients with an average age of 69 (range-50 to 87) underwent a total hip replacement in an NHS District General Hospital. The average BMI was 28 (range-18 to 39) and the average ASA 2.3 (range-1 to 4). The procedure was performed by 3 different surgeons using the same operative standards. A standardised post-operative protocol was followed and the patients were discharged when they were medically fit and had achieved the ward physiotherapy requirements. They were then daily followed up by a community orthopaedic rehabilitation team in patient’s own environment as long as it was required.

The average length of stay was reduced from 7.8 days to 5. There was no increase in complications–or readmissions rate while there were significant cost savings. The waiting list for this surgery was reduced and the patient’s satisfaction was high.

The rapid recovery programme for primary total hip replacement surgeries has been proved to be an efficient method of reducing the length of stay in hospital and consequently the financial costs while it ensures the safe and effective peri-operative management of patients.

Introduction: Geometry of the proximal femur has been identified as a risk factors for hip fracture. It is also suggested that the geometry of the proximal femur can influence the fracture type.

Aims: To identify if proximal geometry and hip fractures are related in two different population groups. Scotland–Monklands General Hospital, Lanarkshire–and Australia -Flinders Medical Centre, Adelaide.

Methods: Retrospective comparison of length and width of the femoral necks in 200 hip fracture patients. 100 patients in the Australian group and 100 patients in the Scottish group were analysed. 50 intracapsular and 50 intertrochanteric fractures were included in each group. All measurements where made from standardised digital anteroposterior radiographs. We attempted to correlate the length and width of the femoral neck with the fracture type.

Results: The populations were matched for age and sex, with the majority of fractures sustained by women. The results for the both populations show that a patient sustaining an intracapsular fracture is more likely to have a longer femoral neck (mean 40.56mm; Scottish population, 39mm; Australian population) than one sustaining an intertrochanteric fracture (mean 31.70mm; Scottish population, 29mm; Australian population) [P < 0.0001]. The femoral neck was also narrower in the intracapsular group. This was significant in Scottish population (mean 38.56mm, P < 0.03), but not in the Australian population (mean 38.3mm, P = 0.067). We also found that men had longer, wider femoral necks (P < 0.0001) compared to the female group.

Discussion: We found that hip fracture pattern is linked to proximal femoral geometry. This relationship is statistically significant in both population groups. Anthropologically, as the human race evolves and people get taller, their femoral neck lengths are increasing. This could translate into a change in the number and type of hip fractures. Intracapsular fractures may predominate and this could have implications on both treatment outcomes and resources for hip fracture patients.