The annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS? We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two – a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients.Objectives
Methods
We performed a case–control study to compare
the rates of further surgery, revision and complications, operating time
and survival in patients who were treated with either an uncemented
hydroxyapatite-coated Corail bipolar femoral stem or a cemented
Exeter stem for a displaced intracapsular fracture of the hip. The
mean age of the patients in the uncemented group was 82.5 years
(53 to 97) and in the cemented group was 82.7 years (51 to 99) We used
propensity score matching, adjusting for age, gender and the presence
or absence of dementia and comorbidities, to produce a matched cohort
receiving an Exeter stem (n = 69) with which to compare the outcome of
patients receiving a Corail stem (n = 69). The Corail had a significantly
lower all-cause rate of further surgery (p = 0.016; odds ratio (OR)
0.18, 95% CI 0.04 to 0.84) and number of hips undergoing major further
surgery (p = 0.029; OR 0.13, 95% CI 0.01 to 1.09). The mean operating
time was significantly less for the Corail group than for the cemented Exeter
group (59 min [12 to 136] Cite this article:
