In a ground-breaking study, UHSussex colleagues have challenged the traditional approach to hip replacement surgery, revealing that patients over 90 can safely undergo total hip replacements (THR) following hip fractures.
A partial hip replacement has traditionally been used to treat hip fractures in patients who are older, with less mobility, whilst THRs have been reserved for younger, fitter patients.
A THR is considered the better option for active patients, as it provides increased movement and improved chances of returning to normal activities. But due to age and fragility, they are commonly avoided in patients aged 90 and over who sustain a hip fracture. Instead, they are performed as elective procedures for arthritis, where the safety has already been well established in this patient group.
However, it is not always the case that a patient aged over 90 has significantly less mobility and they are a group with varying degrees of independence that can tolerate and benefit from this procedure.
UHSussex colleagues carried out a study comparing the safety of emergency THRs to elective THRs in patients between 90 – 99 years-old, exploring data submitted to the National Hip Fracture Database (NHFD) from three UHSussex hospitals over the past 10 years.
Professor Benedict Rogers, Consultant Orthopaedic Surgeon said: “Age alone should not be the deciding factor in determining a patient’s eligibility for surgery. What should matter most is the patient’s overall health, fitness level, and ability to recover. Many older patients are in good health and can handle surgery similarly to younger patients, so this study set out to evidence how these patients were impacted and how we could be improving the care for this specific patient group.”
The group of colleagues used data from our Princess Royal, St Richard’s, and Worthing hospitals, collected from more than 120 patients.
One of their main findings was – despite previous studies suggesting higher mortality rates in patients undergoing emergency THRs compared to elective – this study showed no significant difference in mortality rates, indicating it isn’t more life-threatening.
There was also no key difference in postoperative outcomes, including rates of dislocation and surgery needing to be redone.
Emergency patients in this study spent longer in hospital than elective patients, in accordance with previous studies. This difference in length of stay can be explained by the extensive preoperative planning and careful patient selection that goes into an elective procedure compared to an emergency admission.
The study suggests that it is safe for carefully selected patients over 90 who have sustained a hip fracture, to undergo a total hip replacement. They should have access to the same care and restored mobility as younger patients and that their age alone should not be grounds for this procedure to not go ahead.
Dr Gareth Chan, Speciality Registrar said: “This study highlights the importance of providing our patients with individually tailored care, and chronological age should not play a prime role in deciding what operative model is best for their hip fracture.
“The collaboration across all three of our fragility hip fracture units demonstrates the importance of research across the Trust in improving care for all our patients.”
In comparison to some hospitals, UHSussex’s trauma and orthopaedic service has always aimed to treat patients based on their functional ability, ensuring age hasn’t been the deciding factor for their options in surgery. So, this study supports our approach to caring for this group of patients and achieving the best possible outcomes for them.
The findings align with UHSussex’s Research and Innovation Strategy, which outlines a five-year plan for advancing healthcare research and innovation to ensure excellent care for all patients in Sussex.