Recommendation ID
CG124/3
Question
Displaced intracapsular hip fractures:- What is the clinical and cost effectiveness of large-head total hip replacement versus hemiarthroplasty on functional status, reoperations and quality of life in patients with displaced intracapsular hip fracture?
Any explanatory notes
(if applicable)
Why this is important:- Large-head total hip replacement is a development of traditional total hip replacement, where a larger head makes the joint more stable and hence reduces the risks of dislocation. Three small trials have shown traditional small-head total hip replacement to have better outcomes and function, albeit with an increased dislocation rate in selected groups of patients. The drawback with large-head arthroplasty is the additional implant cost and theatre time. This cost can account for up to 20% of current NHS tariff (up to £2000) and the study aims to address whether this translates to improved patient outcome. The study design for the proposed research would be best addressed by a randomised controlled trial. This would have two arms to compare current standard care (using hemiarthroplasty) with using large-head total hip replacement for patients sustaining displaced intracapsular hip fractures. The primary outcome would be patient mobility at 1 year and secondary outcomes would include functional outcomes, quality of life and cost effectiveness of the intervention.
It would be expected that a sample size of approximately 500 patients would be required to show a significant difference in the mobility, hip function and quality of life (assuming 80% power, p < 0.05). By recruiting through a trauma research network it is estimated that 10 centres would be able to recruit 20 patients per month (from 45 eligible patients) giving a recruitment period of 25 months.

Source guidance details

Comes from guidance
Hip fracture: management
Number
CG124
Date issued
June 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No