NICE guidelines support the use of total hip replacement (THR) in preference to cemented hemiarthroplasty for the treatment of fit and active elderly patients with a displaced intracapsular neck of femur fracture.

We hypothesized that not all patients eligible for a THR received one in our unit.

We performed a prospective cohort study including all consecutive hip fracture patients admitted to our unit over a 6 month period. Case notes and data from the National Hip Fracture Database were evaluated.

Patients were deemed suitable for a THR if they mobilised outdoors with a maximum of one stick, had an abbreviated mental test score of 8 or greater and had an ASA score of 1 or 2.

256 patients sustained a neck of femur fracture during the study period and 36 met the inclusion criteria. 26 (72%) had cemented hemiarthroplasties and 10 (22%) had a THR. THR rates varied with the day of surgery.

At our unit we have a low rate of THR for patients who fulfil the NICE criteria for suitability, however it is around the national average. This could be improved upon by increasing the availability of surgeons who are able to perform THR, especially on weekends.