Reverse hybrid total hip replacement (THR) offers significant theoretical benefits but is uncommonly used. Our primary objective was to evaluate implant survival with all cause revision and revision for aseptic loosening of either component as endpoints. Data was collected prospectively on 1, 088 (988 patients) consecutive reverse hybrid THRs. Mean patient age was 69.3 years (range, 21–94) and mean follow-up was 8.2 years (range, 5–11.3). No patients were lost to follow-up. Overall, 194 (17.8%) procedures were performed in patients under 60 years, 666 (61.1%) were performed in female patients and 349 (32.1%) were performed by a trainee. Acetabular components were ultra-high molecular weight polyethylene in 415 (38.1%) hips, highly cross-linked polyethylene in 669 (61.5%) hips and vitamin E stabilised polyethylene in 4 (0.4%) hips. Femoral stems were collared in 757 (69.7%) hips and collarless in 331 (30.3%) hips. Femoral head sizes were 28 mm in 957 (87.9%) hips and 32 mm in 131 (12.1%) hips. Survival analysis was performed using Kaplan Meier methodology. Log rank tests were used to asses differences in survival by age, gender, head size and surgeon grade.Introduction
Patients/Materials & Methods
A fractured hip is the commonest cause of injury related death in the UK. Prompt surgery has been found to improve pain scores and reduce the length of hospital stay, risk of decubitus ulcer formation and mortality rates. The hip fracture Best Practice Tariff (BPT) aims to improve these outcomes by financially compensating services, which deliver hip fracture surgery within 36 hours of admission. Ensuring that delays are reserved for patients with conditions which compromise survival, but are responsive to medical optimisation, would facilitate enhanced outcomes and help to achieve the 36-hour target. We aimed to identify medical conditions associated with patients failing to achieve the 36-hour cut off, and evaluated whether these were justified by calculating their associated mortality risk. Prospectively collected data from the National Hip Fracture Database (NHFD) and inpatient hospital records and blood results from a single major trauma centre were obtained. Complete data sets from 1361 patients were available for analysis. Medical conditions contributing to surgical delay beyond the BPPT (Best Practice Tariff Target) 36-hour cut off, were identified and analysed using univariate and multivariate regression analyses, whilst adjusting for covariates. The mortality risk associated with each factor contributing to surgical delay was then calculated using univariate and hierarchical regression techniques.Introduction
Methods
