HOW OFTEN ARE NICE RECOMMENDATIONS ON TYPE OF ARTHROPLASTY FOR HIP FRACTURE ADHERED TO AND WHAT IS THE EFFECT ON OUTCOME?

Optimum treatment for intra-capsular hip fracture patients is challenging. To help clinicians with such decisions, the National Institute of health and Care Excellence (NICE) defined practice guidelines, of whom should be considered for a THA (independent ambulator; cognitively intact; medically fit for THA anesthetic), which have been adopted by many international health organizations. The aims of this study were to 1. Assess how many of the THAs performed for hip fractures satisfy NICE criteria; 2. Describe why THAs are performed in cases not satisfying NICE criteria; and 3. Determine whether satisfaction of NICE criteria or practice guidelines (lateral approach and cemented femoral components) are associated with superior outcome post-THA in a contemporary arthroplasty practice. This is a retrospective, multi-surgeon study from an academic center. Of the 2096, hip fractures, without evidence of metastasis, treated between 2010–2022, 195 received a THA under the care of eight arthroplasty surgeons. Electronic records were reviewed to assess patient demographics, mobility status, comorbidities including the Charlson Comorbidity Index (CCI), ASA grade, and surgical details including (approach, implant fixation, bearing diameter). Cases were categorized according to whether NICE criteria were satisfied or not for having a THA. For cases not satisfying NICE criteria, reasons for THA were determined. In addition, cases were categorized on whether NICE guidelines for surgical practice were followed or not. Outcome metrics included complication-, re-operation-, and revision- rates. The mean age of the cohort was 67±9 years old and most patients were female (n=123/63%). Most cases received uncemented implants (87%) and the most common approach utilized was the anterior (39%). Most cases satisfied NICE criteria (n=154; 79%). The two most common reasons for performing a THA, despite not satisfying NICE criteria included osteoarthritis (17/41) and young age (< 65 years-old) (10/41). The overall complication rate was 11% (peri-prosthetic fracture:6, PJI:4, dislocation:3, loosening:1), with 12 (6%) requiring a re-operation and 11 (5.5% requiring revision. When NICE criteria were not satisfied, there was a significantly higher risk of complication rate (17% vs. 4%; p<0.001); re-operation rate (15% vs. 4%) and revision rate (12% vs. 4%). Type of fixation (p=0.7) and surgical approach (p=0.9) (i.e., NICE surgical recommendations) were not associated with post-THA outcome. NICE criteria are valuable tools in the decision making as they are satisfied in most intra-articular hip fractures that undergo THA. The addition of the presence of moderate arthritis as a criterion is likely to improve compliance. Adherence with NICE criteria is associated with improved chances of THA-success and is strongly recommended.