A hip fracture is a serious injury which mostly occurs in older patients. In the UK there are ~60,000 hip fractures every year. A hip fracture is a potentially catastrophic event; approximately 30% of patients will die during the first year following this injury and those that survive will have a significant reduction in their quality of life. The most common type of hip fracture is treated with a partial hip replacement. The implant can be fixed to the patient’s thigh bone with or without the use of ‘bone cement’. Cement is the current standard technique, but there are some risks with this which could be avoided by using ‘uncemented’ implants. These risks, which include an increase in mortality during the first 24 hours after surgery, have prompted an alert from the National Patient Safety Agency. Historically, the outcomes with early uncemented implants were shown to be inferior to the cemented implants currently used, and this has been the justification for the ongoing use of cement. However, since these studies were done, there have been significant improvements in uncemented implant technology and the current, although limited, evidence suggests that these modern uncemented implants may be as good as the cemented implants but without the risks of using cement. This study will be a randomised controlled trial in 1128 participants that will answer the question of whether outcomes with modern uncemented stems are comparable to the cemented stems currently used in the majority of UK centres. Eligible patients will be aged 60 years and over who have sustained a hip fracture which is suitable for a hemiarthroplasty. We will include participants with cognitive impairment. After consent or consultee agreement, participants will be randomised to receive either a modern, uncemented implant or a cemented implant. In this study, the distribution of quality of life scores will be assessed, along with details of participants’ mobility and residential status. The demographic and treatment details along with pre-injury quality of life will be assessed at baseline, and quality of life will be assessed again 1-month and 4-months after the injury.
The aim of this trial is to compare the health-related quality of life in participants over 60 years of age with a displaced intracapsular hip fracture receiving contemporary uncemented hemiarthroplasty versus the current standard-of-care: cemented hemiarthroplasty.
Prof Matthew Costa