AAOS: Better Outcomes When Hip Fracture Repair Occurs Sooner

IF surgery is performed within 24 to 48 hours of a traumatic hip fracture, then patient outcomes are improved, according to an update of the Clinical Practice Guideline for Management of Hip Fractures in Older Adults (age 55 years and older) by the American Academy of Orthopaedic Surgeons (AAOS).

This update replaced the 1st edition released in 2014, which covered just patients 65 years and older. In it, over 80% of the evidence-based recommendations have been refined and improved to decrease complications and improve outcomes for all hip fracture patients.

The revised guideline also emphasizes the importance of an interdisciplinary care program when treating these patients.

"Hip fractures are a very serious public health issue, specifically for our seniors," said Mary O'Connor, M.D., FAAOS, co-chair of the clinical practice guideline development group.

"For this patient population, a hip fracture can become a life-altering event that requires surgery and may result in a decreased quality of life, increased morbidities and a higher rate of mortality within one year after surgery.”

While moderate evidence in 2014 supported the recommendation that hip fracture surgery occurring within 48 hours of admission is associated with better outcomes, recent data shows improved outcomes with surgery within 24 hours.

"Ideally the time to surgery should be as soon as safely possible based on variation in resources at the facility and the given surgical team," added Dr. O'Connor.

Interdisciplinary programs were also strongly supported in the 2014 recommendations, but only for patients with mild to moderate dementia. The new recommendation expands the use of such programs for all hip fracture patients to decrease mortality and complications

"These two recommendations go hand in hand," said Julie Switzer, M.D., FAAOS, co-chair of the clinical practice guideline workgroup.

"An interdisciplinary care program should begin the moment a patient is admitted to the hospital as it is an essential part of driving efficiencies to get a patient into the operating room within 24-48 hours. Following surgery, this team, which can consist of geriatric, orthopedic, nursing, dietary and rehabilitation providers, are the key to driving good outcomes and helping patients navigate this sentinel event."

The updated recommendations also now provide strong evidence—updated from moderate in 2014—for the use of cemented femoral stems for patients undergoing arthroplasty for femoral neck fractures.

Their use is associated with reduced periprosthetic fracture risk and improved short term outcomes. The recommendation though also acknowledges a risk for increased surgical time and blood loss.

In addition, the clinical guidelines now state that for patients undergoing treatment of femoral neck fractures with hip arthroplasty, one surgical approach—direct anterior, lateral or posterior—is not superior to the other. This is different from the 2014 guidance in which the posterior surgical approach was considered inferior because of higher dislocation rates.