Quality standard

Quality statement 3: Intracapsular fracture

Quality statement 3: Intracapsular fracture

Quality statement

Adults with displaced intracapsular hip fracture have a total hip replacement if clinically eligible, rather than hemiarthroplasty. [2012, updated 2017]

Rationale

Many people with hip fracture are concerned with recovery and getting back to usual activity. Total hip replacement is associated with improved functional status compared with hemiarthroplasty, if the patient was active before the fracture, is not cognitively impaired and is medically fit for the procedure.

Quality measures

Structure

Evidence of local arrangements to perform total hip replacement if people with displaced intracapsular fracture are clinically eligible, rather than hemiarthroplasty.

Data source: Local data collection.

Process

Proportion of people with displaced intracapsular fracture and eligible for total hip replacement who receive total hip replacement.

Numerator – the number in the denominator who receive total hip replacement.

Denominator – the number of people with displaced intracapsular fracture and eligible for total hip replacement.

Data source: Local data collection. The National Hip Fracture Database records procedure type for intracapsular displaced fracture and cementing of arthroplasties.

Outcome

Functional status at 1 and 5 years after total hip replacement for displaced intracapsular fracture.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (hospitals) ensure that total hip replacement is performed for displaced intracapsular fracture, rather than hemiarthroplasty, if the person is assessed as clinically eligible.

Healthcare professionals (orthopaedic surgeons) treat displaced intracapsular fracture using total hip replacement, rather than hemiarthroplasty, if the person is assessed as clinically eligible.

Commissioners (clinical commissioning groups) ensure that orthopaedic services perform total hip replacement, rather than hemiarthroplasty, to treat displaced intracapsular fracture in people who are clinically eligible.

People with a fracture inside the socket of their hip joint and where the bones have moved out of position (called a displaced intracapsular fracture) who were fit and active before the fracture have both parts of the hip joint (the ball and socket) replaced with artificial parts (called a total hip replacement).

Source guidance

Hip fracture: management. NICE guideline CG124 (2011, updated 2017), recommendations 1.6.2 and 1.6.3

Definitions of terms used in this quality statement

Intracapsular fractures

Fractures above the insertion of the capsular attachment of the hip joint are called intracapsular. [NICE's full guideline on hip fracture]

Clinical eligibility for total hip replacement

Patients with a displaced intracapsular fracture who:

  • were able to walk independently out of doors with no more than the use of a stick and

  • are not cognitively impaired and

  • are medically fit for anaesthesia and the procedure.

[NICE's guideline on hip fracture, recommendation 1.6.3]