New publication from Prof Middleton looking at revision hip surgery

In the Bone and Joint Journal this month, Prof Middleton and colleagues from across the UK, have had their paper titled “A multicentre comparative analysis of fixation versus revision surgery for periprosthetic femoral fractures following total hip arthroplasty with a cemented polished taper-slip femoral component” published.

ORI Hip fellow, Seb Crosswell has summarised the research and it’s key findings.

The incidence of fracturing of the bone around hip replacements in the UK is increasing by 13% each year. These injuries are a serious complication after routine hip replacement and usually require surgical management, which can be costly, complex and have a high complication rate. The majority of these patients are above the age of 70 years and often have significant medical co-morbidities, adding to the complexity of these surgical cases.

A recent study performed across multiple hospitals across the United Kingdom compared two different surgical techniques used to manage these fractures. One of the techniques is, removal of the entire implant and replacing it with a new revision type hip replacement (revision) and the other is to fix the fracture with a plate and screws and leave the original hip replacement in situ (fixation).

A total of 317 patients were reviewed in this study and followed up for an average of 3.6 years after their operation. The teams looked at types of fractures, time to surgery, blood loss, complications, reoperation rates, death rates, dislocation and escalation of care to intensive units. Both fixation and revision groups were compared to see whether there was a difference between the two operative techniques. Data was gathered and submitted from multiple hospitals across the UK.

The researchers found that the revision type surgery had a higher reoperation rate, longer surgical waiting time, higher blood transfusion requirement and higher intensive care requirement, when compared with the fixation group of patients. The fixation method was successful, if the fragments of bone around the hip replacement were fixed back into their original position.

The key learning points from this high quality, multicentre study, concluded that fixation was a safe and resourceful option in managing these patients. In revision surgery, if only one of the components was changed then the patients had a higher rate of dislocation post operatively. Finally, they recommended that a more protective cup against dislocation be used in revision operations. Patient satisfaction and functional assessment of these patients was not performed; however, we can assume that reduction of reoperations and complications would influence these factors. Hopefully, this study can reassure surgeons that fixation is a safe and effective surgical technique in these patients.