OUTCOMES AT EIGHT YEARS FROM A SINGLE CENTRE CONTRIBUTING TO THE WHITE3 HEMI TRIAL: COMPARING THE THOMPSON HEMIARTHROPLASTY WITH THE EXETER POLISHED TAPERED STEM AND UNITRAX MODULAR HEAD IN THE TREATMENT OF DISPLACED INTRACAPSULAR FRACTURES OF THE HI

The WHiTE3:HEMI Trial recruited patients with an intracapsular hip fracture to be randomised to receive either the Thompson hemiarthroplasty or the Exeter polished tapered stem and Unitrax modular head. Results demonstrated no difference in mortality or health-related quality of life at 4 months. There were small but statistically insignificant differences in postoperative mobility (OR=0.76, p=0.107). The aim of this study is to review outcomes at eight years for patients recruited into the WHiTE3:HEMI Trial at our institution. Patient records, including clinical notes and imaging, were linked to data from the Surgical Site Infection Surveillance Service, the Office of National Statistics, and the National Hip Fracture Database. Patient characteristics, incidence of periprosthetic fractures, reoperation rates, revision surgery, and mortality were compared between the two groups. Patients were analysed ‘as randomised’. By the nature of the study, assessments were not blinded. 147 Thompson patients were compared with 125 Exeter Unitrax patients. There were no differences in age, gender, ASA grade, AMTS, Nottingham Hip Fracture Score, grade of operating surgeon or residence on admission. In the Thompson group, there were 12/147 (8.2%) surgical complications, 5/147 (3.4%) reoperations and 0/147 periprosthetic fractures. In the Exeter Unitrax group, there were 11/125 (8.8%) surgical complications (p=0.851), 6/125 (4.8%) reoperations (p=0.560) and 3/125 periprosthetic fractures (p=0.059). Eight-year Thompson cumulative implant survivorship was 97.2% and Exeter Unitrax 96.0% (p=0.749). There were no differences in 30-day or 4-month mortality rates. One-year mortality rates were 36.1% in Thompson and 20.0% in Unitrax (difference 16.1%, 95% CI (0.2, 31.0), p=0.004). Pooled mortality at eight years was 86.8%. At one year, a significantly higher mortality rate was noted in the Thompson group compared to the Exeter Unitrax. Long term, Thompson and Exeter Unitrax demonstrate equivalent and low reoperation rates and excellent implant survivorship. Further studies may look to validate these findings and explore whether differences in postoperative mobility status influence the risk of mortality.