Hip fracture patients have worse outcomes compared to hip replacement patients

Many surgeons and physicians have assumed that patients undergoing surgery for a hip fracture have a higher risk of death and major complications compared to patients undergoing an elective total hip replacement because patients having surgery for a hip fracture are older and have more chronic diseases than patients having an elective hip surgery.

A new study published in JAMA today says the hip fracture patients have worse outcomes and this is not entirely explained by age or chronic illness.

The researchers studied almost 700,000 hip surgery patients more than 45 years old in France between 2010 and 2013, and found that the total hip replacement patients were younger, more commonly men and had less other medical problems than hip fracture patients.

They also found that, indeed, there were more deaths among the hip fracture patients, with a total of 3.4 per cent dying before hospital discharge compared to 0.18 percent of total hip replacement surgery patients.

Even when the demographics of the patients were matched by gender, age and medical conditions, they found hip fracture patients had a 1.8 per cent chance of dying compared to 0.3 per cent of elective hip replacement patients, and those with a hip fracture had a 5.9 percent chance of major post operation complications, compared to 2.3 per cent of those patients who underwent an elective hip replacement.

The research team was led by Dr. Yannick Le Manach, an assistant professor of anesthesia for the Michael G. DeGroote School of Medicine of McMaster University and a member of the Population Health Research Institute of McMaster and Hamilton Health Sciences.

"The fact that the hip fracture patients were older and had more health problems does account for some of the difference in outcomes," Le Manach said. "But it may be that hip fracture is tied to other physiologic processes that aren't present in the circumstances of people going for an elective hip replacement. More research is needed."