The management of patients with displaced intra-capsular hip fractures is usually a hip hemiarthoplasty procedure. NICE guideline 124 published in 2011 suggested that Total Hip Replacement (THR) surgery should be considered in a sub group of patients with no cognitive impairment, who walk independently and are medically fit for a major surgical procedure.

The Royal Devon and Exeter Hospital manages approximately 550 patients every year who have sustained a fracture of neck of femur, of which approximately 90 patients fit the above criteria. Prior to the guideline less than 20% of this sub-group were treated with a THR whereas after the guideline over 50% of patients were treated with THR, performed by sub-specialist Hip surgeons.

This practice is financially viable; there is no apparent difference in the overall cost of treating patients with THR. The effect of adoption of the NICE guideline was examined using 100 % complete data from 12 month post operative follow up. Only the Hemi-arthroplasty patients were significantly less likely to have stepped down a rung of independent living. Both THR and Hemi-arthroplasty patients were significantly less likely to have stepped down a rung of walking ability, but there was no significant difference between THR and Hemi-arthroplasty groups. Revision rates remained negligible.