Displaced Intracapsular Neck of Femur Fractures Treated with or without Total Hip Replacement – The Accuracy of the National Hip Fracfture Database Data: A Five Year Retrospective Analysis

Background:

According to 2018 National Hip Fracture Database (NHFD) annual report only 31.4% of intracapsular neck of femur fracture (NOF) patients eligible for Total Hip Replacement (THR) received this operation.The aim was to Identify compliance rates of THR for NOF and rationale for management in our unit.

Methods:

During the period January 2014 to December 2018, patients identified by NHFD as eligible for THR for displaced NOF were included. Day of injury and surgery was identified in excel, type and reasons for performing particular procedure were identified from the notes. Demographics, pre-operative Abbreviated Mental Test Score (AMTS), time to surgery, delay and length of stay were analysed using chi-squared test.

Results:

Only 138 out of 315 patients eligible for THR underwent THR. The rest (177) had alternative management (mainly hip hemiarthroplasty or fixation). Patients aged 60-79 years were more likely to receive THR than >79 years (p<0.05). THR patients had 0.4 higher AMTS and length of stay was shorter (9.5 vs 12.6) (p<0.05). There were significantly more females and left sided fractures but neither was relevant to type of surgery performed. Waiting time for THR and non-THR surgery was similar (1.4 vs. 1.1 day) (p>0.05) with no “weekend effect”. Consultant level documented reasons for not performing THR was present in 93% of notes. Reasons included patient choice, significant medical, mental health and mobility issues. When rationale for surgical decision-making is taken into consideration, our unit had 93% compliance for performing THR for displaced NOF in >60 year olds compared to published national rate of 44%.

Conclusion:

Data requested by NHFD is not sufficient to decide whether patients meet criteria for THR, potentially skewing the result on THR for NOF performance. A column in NHFD database allowing units to record reasons for not performing THR would give more credibility to published data.

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