VARIATION AND TRENDS OF TOTAL HIP ARTHROPLASTY FOR FRACTURE ACROSS WALES

The treatment of displaced intracapsular fracture varies significantly across locations and over time. The National Hip Fracture Database (NHFD) identified the rolling one-year average of eligible patients who were treated with Total Hip Arthroplasty (THA) since March 2012 to February 2026 in Wales. Key guidelines for THA treatment for hip fracture patients include the 2017 NICE guidelines update specifying for which patients THA should be considered and the 2023 update which added a further condition of two years independent living to the previous guidelines. Data for Wales demonstrates the trend of annual average of THA use. There is a relationship between the publication of the HEALTH trial in September 2019 and a significant fall in THA use in the subsequent 2 years, from 31.24% to 21.11%, having previously been on an upward trend after the 2017 NICE update. The January 2023 NICE update again led to a fall in THA numbers from 22.16% to 13.20% 3 years later. 12 Welsh hospitals submit to the NHFD. The rates THA for each hospital is available to the public on the NHFD and can be compared. There is a wide variation in practise across Wales, the mean difference of all THA use in 14 years between the highest and lowest hospitals was 33.93%. The variability of THA use was also heterogeneous across Wales. The highest and lowest ranges of THA use over time was 70% and 25.52%. As of February 2026, the highest and lowest THA use was 51.11% and 0%, respectively.