Can the Nottingham Hip Fracture Score Predict Total Hip Replacement Versus Hemiarthroplasty Candidates?

Area of Science:

• Orthopedic Surgery
• Geriatric Trauma
• Arthroplasty

Background:

• The optimal surgical management for displaced intracapsular hip fractures, specifically total hip replacement (THR) versus hemiarthroplasty, remains a clinical dilemma.
• Current evidence presents challenges in procedure selection, necessitating objective decision-making tools.
• The Nottingham Hip Fracture Score (NHFS) was introduced to standardize and objectify treatment choices.

Purpose of the Study:

• To evaluate the utility of the Nottingham Hip Fracture Score (NHFS) in guiding the choice between total hip replacement (THR) and hemiarthroplasty for displaced intracapsular hip fractures.
• To compare one-year mortality and discharge destinations between THR and hemiarthroplasty cohorts, stratified by NHFS.
• To identify patient subgroups, particularly those with higher NHFS scores and advanced age, who may benefit more from THR.

Main Methods:

• Retrospective analysis of 1210 patients (2019-2023) undergoing either THR (n=228) or hemiarthroplasty (n=982) for displaced intracapsular hip fractures.
• Calculation of NHFS for all patients, with subgroup analysis focusing on NHFS scores of 4-6 and patients over 80 years old with NHFS 4-6.
• Primary outcomes assessed were one-year mortality and discharge destination; statistical analysis was performed using IBM SPSS Statistics.

Main Results:

• Hemiarthroplasty patients were older (mean age 82.2 years) and had significantly higher mean NHFS (6.0) and one-year mortality (36.2%) compared to THR patients (mean age 74.6 years, mean NHFS 3.5, mortality 3.5%).
• THR was associated with a higher likelihood of discharge home (65% vs. 39% for hemiarthroplasty) in the overall cohort.
• In the NHFS 4-6 subgroup, THR demonstrated significantly lower mortality (3.4% vs. 29.6%) and more frequent home discharge (77.7% vs. 43.9%) compared to hemiarthroplasty.

Conclusions:

• Patients undergoing hemiarthroplasty tend to be older, have higher NHFS scores, and experience greater mortality.
• For patients with NHFS scores of 4-6, THR is associated with reduced mortality and more favorable discharge outcomes, suggesting its benefit in this higher-risk group.
• The NHFS can potentially enhance existing guidelines (e.g., NICE) by aiding in the selection of patients most likely to benefit from THR over hemiarthroplasty.