An editorial by Harman Chaudhry in the British Medical Journal has called for more evidence to be gathered regarding whether full or partial hip replacements are more effective for patients with fractured hips.
At present, people who are eligible for total hip replacements (also referred to as total hip arthroplasty or THA) under NICE guidelines are only receiving them in 32% of cases. Mr Chaudhry suggests that this is due to disagreement between clinicians as to which of the treatment options is better.
The level of variation is certainly concerning, particularly because it appears that the type of hip replacement used at present is more likely to be determined by biases rather than evidence. Authors of a study referred to by Mr Chaudhry have discovered that the type of treatment which patients receive varies considerably in accordance with where they live, how wealthy they are and whether they are treated on a weekend.
Patients are entitled to expect that their treatment is determined by evidence-based medicine rather than by chance and it is to be hoped that this study will lead to a more consistent approach.
Perry and colleagues (doi:10.1136/bmj.i2021) analyzed data from the UK’s National Hip Fracture Database to determine compliance with guidelines for THA from the National Institute for Health and Care Excellence (NICE) and to identify predictors of use of THA.6 Their large observational study included 114 119 adults aged 60 or over with displaced intracapsular fractures of the femoral neck. NICE recommends THA for those with good cognitive and physical function who are fit enough for anesthesia and surgery. The degree of non-adherence to this guidance was remarkable: only 32% of ostensibly eligible adults received THA, and, of those who underwent the procedure, 42% did not meet the NICE eligibility criteria.