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Aims: To determine if patient ethnicity among patients with a hip fracture influences the type of fracture, surgical care, and outcome., Methods: This was an observational cohort study using a linked dataset combining data from the National Hip Fracture Database and Hospital Episode Statistics in England and Wales. Patients' odds of dying at one year were modelled using logistic regression with adjustment for ethnicity and clinically relevant covariates., Results: A total of 563,640 patients were included between 1 April 2011 and 1 October 2020. Of these, 476,469 (85%) had a coded ethnicity for analysis. Non-white patients tended to be younger (mean 81.2 vs 83.0 years), and were more commonly male (34.9% vs 28.5%; p < 0.001). They were less likely to be admitted from institutional care (12.9% vs 21.8%; p < 0.001), to have normal cognition (53.3% vs 62.0%; p < 0.001), and to be free of comorbidities (22.0% vs 26.8%; p < 0.001), but were more likely to be from the most deprived areas (29.4% vs 17.3%; p < 0.001). Non-white patients were more likely to experience delay to surgery for medical reasons (14.8% vs 12.7%; p < 0.001), more likely to be treated with an intramedullary nail or a sliding hip screw (52.5% vs 45.1%; p < 0.001), and less likely to be mobilized by the day after surgery (74.3% vs 79.0%; p < 0.001). Mortality was higher among non-white inpatients (9.2% vs 8.4% for white), but was lower at one year after hip fracture (26.6% vs 30.3%)., Conclusion: Our study identified serious problems with the quality of NHS ethnicity data. Despite this, we have shown that there is complex variation in case-mix and hip fracture morphology between ethnic groups. We have also identified variations in care received between ethnic groups, and that disparities in healthcare may contribute to poorer outcome. Inpatient mortality is higher in non-white patients, although this finding reverses after discharge, and one-year mortality is lower. Patients from ethnic minority backgrounds experience disparities in healthcare, however at one year postoperatively non-white patients have a statistically significant lower mortality after controlling for relevant clinical covariates., Competing Interests: S. Nisar and H. Pandit report receipt of the RCSEd Pump-Priming Grant (paid to Leeds Institute of Rheumatic and Musculoskeletal Medicine), related to this study. A. Johansen reports an unpaid position as Geriatrician Clinical Lead at the National Hip Fracture Database (NHFD), the national clinical audit of this condition. A. Johansen’s hospital is reimbursed for his time by the Royal College of Physicians, which manages the NHFD., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Background: The aim of this study is to estimate risk factors for intraoperative periprosthetic femoral fractures (IOPFF) and each anatomic subtype (calcar crack, trochanteric fracture, femoral shaft fracture) during primary total hip arthroplasty., Methods: This retrospective cohort study included 793,823 primary total hip arthroplasties between 2004 and 2016. Multivariable regression modeling was used to estimate relative risk of patient, surgical, and implant factors for any IOPFF and for all anatomic subtypes of IOPFF. Clinically important interactions were assessed using multivariable regression., Results: Patient factors significantly increasing the risk of fracture were female gender, American Society of Anesthesiologists grade 3 to 5, and preoperative diagnosis including avascular necrosis of the hip, previous trauma, inflammatory disease, pediatric disease, and previous infection. Overall risk of IOPFF associated with age was greatest in patients below 50 years and above 80 years. Risk of any fracture reduced with computer-guided surgery and in non-National Health Service hospitals. Nonposterior approaches increased the risk of shaft and trochanteric fracture only. Cementless implants significantly increased the risk of only calcar cracks and shaft fractures and not trochanteric fractures., Conclusion: Fracture risk increases in patients younger than 50 and older than 80 years, females, American Society of Anesthesiologists grade 3 to 5, and indications other than primary osteoarthritis. Large cumulative reduction in IOPFF risk may occur with use of cemented implants, posterior approach, and computer-guided surgery., Level of Evidence: Level 3b (cohort study)., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aims: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls., Patients and Methods: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression., Results: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001)., Conclusion: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.

Background: Studies have suggested that Trabecular Metal (TM)-coated acetabular components may reduce implant failure following revision total hip arthroplasty. However, these studies have predominantly been limited to small, single-center cohorts, with many lacking a comparator group. Using National Joint Registry data from England and Wales, we compared re-revision rates following revision total hip arthroplasty between TM and non-TM-coated acetabular components from 1 manufacturer., Methods: This retrospective observational study included all revision total hip arthroplasties performed with use of 1 of 4 cementless acetabular components produced by the same manufacturer (Zimmer Biomet). The acetabular components either had a TM surface coating (TM Modular and Continuum designs) or a non-TM surface coating (Trilogy and Trilogy IT designs). Revision total hip arthroplasties with TM and non-TM implants were matched for multiple potential patient and surgical confounding factors using propensity scores. Outcomes following revision total hip arthroplasty (re-revision for all acetabular indications, aseptic acetabular loosening, or infection) were compared between matched groups using competing risk regression analysis. Analyses were repeated in a subgroup initially revised for infection., Results: Of 3,862 matched revision total hip arthroplasties (1,931 in the TM group and 1,931 in the non-TM group), the overall prevalence of acetabular re-revision (2.7%; 95% confidence interval [CI] = 2.1% to 3.2%), re-revision for aseptic acetabular loosening (0.96%; 95% CI = 0.68% to 1.3%), and re-revision for infection (1.4%; 95% CI = 1.0% to 1.8%) were low. Six-year rates of re-revision for all causes (subhazard ratio [SHR] = 0.91; 95% CI = 0.61 to 1.35; p = 0.636), aseptic acetabular loosening (SHR = 1.32; 95% CI = 0.68 to 2.53; p = 0.410), and infection (SHR = 0.68; 95% CI = 0.39 to 1.20; p = 0.165) were similar between revision total hip arthroplasties with TM and non-TM coatings. Of 247 total hip arthroplasties initially revised for infection (116 TM and 131 non-TM), the rates of re-revision for all causes (SHR = 0.48; 95% CI = 0.15 to 1.56; p = 0.225), aseptic acetabular loosening (SHR = 0.54; 95% CI = 0.05 to 5.74; p = 0.608), and infection (SHR = 0.82; 95% CI = 0.28 to 2.36; p = 0.706) were similar between the TM and non-TM groups., Conclusions: Following revision total hip arthroplasty, TM-coated acetabular components had a low risk of both aseptic and septic re-revision, with rates that were comparable with those of non-TM components. Extended follow-up of large revision total hip arthroplasty cohorts will establish whether TM components have any clinical benefit over non-TM designs when used in patients with similar acetabular bone stock., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Trabecular metal (TM)-coated acetabular components are increasingly used in both primary and revision total hip arthroplasty (THA). However, previous studies assessing TM acetabular components have been small single-center cohorts with most lacking a control group. We compared revision rates following primary THA between TM and non-TM-coated acetabular components., Methods: A retrospective observational study was performed using National Joint Registry data, which included primary THAs with the same cementless acetabular component (either TM or non-TM coated). TM and non-TM implants were matched for multiple potential confounding factors using propensity scores. Outcomes following primary THA (revision for all-cause acetabular indications, aseptic acetabular loosening, and infection) were compared between matched groups using competing risk regression analysis., Results: In 18,200 primary THAs (9100 TM and 9100 non-TM), the overall prevalence of acetabular revision, revision for aseptic acetabular loosening, and septic revision was 1.2%, 0.13%, and 0.59% respectively. Five-year revision rates for all-causes (1.0% vs 1.8%, sub-hazard ratio [SHR] 0.57, 95% confidence interval [CI] 0.43-0.76, P < .001), aseptic acetabular loosening (0.1% vs 0.2%, SHR 0.35, 95% CI 0.14-0.90, P = .029), and infection (0.5% vs 0.9%, SHR 0.51, 95% CI 0.34-0.76, P = .001) were all lower in TM compared with non-TM implants., Conclusion: Following primary THA, TM-coated acetabular implants had a reduced risk of both aseptic and septic revision compared with non-TM implants. Although absolute differences in revision risk were small, they may be clinically significant if TM designs were implanted in more complex cases., (Copyright © 2017 Elsevier Inc. All rights reserved.)