A prospective study on total hip arthroplasty outcome in hip fracture compared with matched elective cohort

Abstract

Background: We conducted a prospective study to compare the outcomes of THA for hip fractures with a best-matched elective cohort. Method: We prospectively reviewed patients underwent THA for hip fractures from 2017 to 2019. The modified Harris Hip Score (mHHS) and complications were recorded. Our control group was elective THA cases matched for the month of operation, age, gender, implants, side of operation and surgeon’s grade. Unmatched cases were excluded. Results: Forty-one THA for hip fractures and forty-one matched elective THA were compared. The total modified Harris Hip Score [mHHS (total)] was significantly lower preoperatively in elective cohort (trauma vs. elective: 60.3 vs. 41.4, P<0.001) and achieved significantly higher score than trauma cohort one-year postoperatively (82.6 vs. 88.2, P= 0.029). The trauma cohort had similar mHHS (function) pre- and postoperatively, and no significant difference was witnessed between both cohorts postoperatively (35.1 vs. 37.6, P= 0.142). The mHHS (pain) was significantly higher in trauma cohort preoperatively (19.8 vs. 12.7, P=0.034), but the elective cohort achieved significantly higher mHHS (pain) than trauma cohort at one-year postoperative (40.1 vs. 42.7, P=0.027). Both cohorts had similar complication rates. Conclusions: This is the first matched prospective study on hip fracture patients that underwent THA, with one year follow up results and the involvement of preoperative and postoperative functional outcomes. With careful patient selection, trauma THA patients can return to their pre-injured function within a year and had comparable function scores with elective THA patients, without increased complication rates.