Grant: Operating Grant

Hip fractures occur in 280,000 Americans and 36,000 Canadians annually. The number of hip fractures is likely to exceed 500,000 a year in the United States and 88,000 a year in Canada. Hip fractures are associated with serious temporary and sometimes permanent impairment of independence and quality of life. Hip fractures can be fixed with partial (hemi) or total hip replacement (arthroplasty). Some surgeons support hemi-hip arthroplasty (HA) because it can reduce dislocation, deep vein thrombosis, lessen blood loss, shorten operating times, and is a technically less demanding procedure. Others support total hip arthroplasty (THA) because they believe it improves patient function and quality of life. Previous hip fracture trials have had study design limitations, specifically small sample sizes and surgeon expertise, leading to less certainty in the study results. This has left the best surgical approach for displaced femoral neck fractures unresolved. Therefore we propose a large multi-centre, concealed expertise-based randomized trial design that includes 1,434 patients assigned to treatments performed by surgeons considered to have expertise in the surgery to which the patient has been randomized, or who has expertise in both procedures. Surgeons across North America, Europe, Australia, and Asia will participate. Study personnel will monitor critical aspects of peri-operative care and rehabilitation. The primary outcome is revision surgery within 2 years of the arthroplasty. The secondary outcomes include health-related quality of life, functional outcomes and mobility, and health-related quality of life. We will assess patients at hospital admission, 1 week, 10 weeks, 6 months, 9 months, 12 months, 18 months, and 24 months after surgery. This trial will not only change current orthopaedic practice, but will set a benchmark for the conduct of future orthopaedic trials.