This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals.Aims
Methods
We present the development of a day-case total hip arthroplasty (THA) pathway in a UK National Health Service institution in conjunction with an extensive evidence-based summary of the interventions used to achieve successful day-case THA to which the protocol is founded upon. We performed a prospective audit of day-case THA in our institution as we reinitiate our full capacity elective services. In parallel, we performed a review of the literature reporting complication or readmission rates at ≥ 30-day postoperative following day-case THA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed.Aims
Methods
Surgical treatment of hip fracture is challenging; the bone is porotic and fixation failure can be catastrophic. Novel implants are available which may yield superior clinical outcomes. This study compared the clinical effectiveness of the novel X-Bolt Hip System (XHS) with the sliding hip screw (SHS) for the treatment of fragility hip fractures. We conducted a multicentre, superiority, randomized controlled trial. Patients aged 60 years and older with a trochanteric hip fracture were recruited in ten acute UK NHS hospitals. Participants were randomly allocated to fixation of their fracture with XHS or SHS. A total of 1,128 participants were randomized with 564 participants allocated to each group. Participants and outcome assessors were blind to treatment allocation. The primary outcome was the EuroQol five-dimension five-level health status (EQ-5D-5L) utility at four months. The minimum clinically important difference in utility was pre-specified at 0.075. Secondary outcomes were EQ-5D-5L utility at 12 months, mortality, residential status, mobility, revision surgery, and radiological measures.Aims
Methods
We assessed the difference in hospital based and early clinical
outcomes between the direct anterior approach and the posterior
approach in patients who undergo total hip arthroplasty (THA). The outcome was assessed in 448 (203 males, 245 females) consecutive
patients undergoing unilateral primary THA after the implementation
of an ‘Enhanced Recovery’ pathway. In all, 265 patients (mean age:
71 years (49 to 89); 117 males and 148 females) had surgery using
the direct anterior approach (DAA) and 183 patients (mean age: 70
years (26 to 100); 86 males and 97 females) using a posterior approach.
The groups were compared for age, gender, American Society of Anesthesiologists
grade, body mass index, the side of the operation, pre-operative
Oxford Hip Score (OHS) and attendance at ‘Joint school’. Mean follow-up
was 18.1 months (one to 50).Aims
Patients and Methods
The aims of this study were to determine the
functional impact and financial burden of isolated and recurrent dislocation
after total hip arthroplasty (THA). Our secondary goal was to determine
whether there was a difference between patients who were treated
non-operatively and those who were treated operatively. We retrospectively reviewed 71 patients who had suffered dislocation
of a primary THA. Their mean age was 67 years (41 to 92) and the
mean follow-up was 3.8 years (2.1 to 8.2). Because patients with recurrent dislocation were three times
more likely to undergo operative treatment (p <
0.0001), they
ultimately had a significantly higher mean Harris Hip Score (HHS)
(p = 0.0001), lower mean Western Ontario and McMaster Universities
Arthritis Index (WOMAC) scores (p = 0.001) and a higher mean SF-12
score (p <
0.0001) than patients with a single dislocation. Likewise,
those who underwent operative treatment had a higher mean HHS (p
<
0.0001), lower mean WOMAC score (p <
0.0001) and a higher
mean SF-12 score (p <
0.0001) than those who were treated non-operatively. Recurrent dislocation and operative treatment increased costs
by 300% (£11 456;
p <
0.0001) and 40% (£5217; p <
0.0001), respectively. The operative treatment of recurrent dislocation results in significantly
better function than non-operative management. Moreover, the increase
in costs for operative treatment is modest compared with that of
non-operative measures. Cite this article:
Revision arthroplasty of the hip is expensive
owing to the increased cost of pre-operative investigations, surgical implants
and instrumentation, protracted hospital stay and drugs. We compared
the costs of performing this surgery for aseptic loosening, dislocation,
deep infection and peri-prosthetic fracture. Clinical, demographic
and economic data were obtained for 305 consecutive revision total
hip replacements in 286 patients performed at a tertiary referral
centre between 1999 and 2008. The mean total costs for revision
surgery in aseptic cases (n = 194) were £11 897 (
