Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

The White 5 trial compared implants fixed with bone cement against uncemented implants for hip fractures treated with hemiarthroplasty.

Doctor looking at total hip replacement X-ray film with blurred hospital background

Hip fracture in older people is a global problem that negatively affects patients' quality of life and places a burden on healthcare systems. In the UK there are about 70,000 hip fractures every year, and each is a potentially catastrophic event; approximately 20% of patients will die during the first year following the injury, and those who survive suffer pain and lack of mobility.

"About half of all hip fractures happen at the neck of the femur, or thighbone," said Matt Costa, Professor of Orthopaedic Trauma at NDORMS. "These are treated with a hip replacement procedure called hemiarthroplasty, in which the head of the femur is replaced with a metal implant. The most common method to fix the implant in place has been to use cement bonded to the patient's bone but this isn't without its risks during surgery. New implants have been designed without cement, so we set up the White 5 trial to compare any difference between the treatments and the effect on patient outcomes."

The challenge with fixing implants to the bone is that they can loosen if not bonded securely to the patient's thighbone, causing pain and restricting day to day activities. Bone cement provides reliable bonding to the bone but there is a small risk that a patient's blood pressure may drop as the cement is injected into the bone. The newer uncemented implants have been designed to provide better integration with the bone and are claimed to provide reliable fixation and an early return to normal activities, without the risks of bone cement.

The White 5 trial, a randomised controlled trial across multiple hospitals in the UK, recruited people over age 60 with a hip fracture requiring hemiarthroplasty. 610 patients were recruited to receive the cemented treatment, and 615 to the modern uncemented treatment. The primary outcome measure was the patient's quality of life measured at 1 month, 4 months and 12 months.

Published in The New England Journal of Medicine the study found that patients having the cemented treatment showed a statistically significant improvement in quality of life at a month and 4 months, but less difference at 12 months. Secondary fractures at the site of the implant were more common in the uncemented than cemented group. There was no difference between the two groups in terms of the number of people who died.

Matt Costa said: "Cemented implants provide modest but important improvements in quality of life compared with uncemented implants. The cemented implants also reduce costs for the NHS. Overall, we would recommend clinicians use cemented implants for patients having a hemiarthroplasty for their hip fracture."

The UK National Institute for Health Research (NIHR) funded the research supported by the Oxford Biomedical Research Centre.


Patient and Public Involvement (PPI)

The involvement of patients and public in trials to advance research and treatments can't be underestimated.

Alwin McGibbon, who became involved in PPI groups 15 years ago, saw the role as important in many ways. "Back when I joined, hospitals generally each had their own outcome measures, so it was like comparing apples and pears because they would have a different set of questions. I've been involved in White 5 on and off since it started, and part of my PPI work was to develop the outcome measures for the trial, which have been now adopted by most of the hospitals."

That was part of the motivation to be involved but her PPI work also extended to patient facing activities. "I was quite heavily involved, with other members of PPI, in putting documents together such as consent forms, which could include a lot of NHS terminology and jargon. We helped put them into clear English so a person on the street may be able to understand it, and what's actually happening to them. We also helped in creating leaflets for those involved and suggested putting it online so that people could see the difference they've made."

"It's nice to see the whole thing through from the beginning and knowing that you're making a difference for patients."

Similar stories

Yoshi Itoh wins the International Dupuytren Award 2022

Yoshi Itoh, Associate Professor and Principal Investigator Cell Migration Group at the Kennedy Institute has been awarded the International Dupuytren Award 2022.

Taking a break from immune-suppressing medicines doubles the antibody response to COVID-19 booster vaccination

The Oxford Clinical Trials Research Unit (OCTRU) at NDORMS played a key role in the VROOM study which found that pausing immune-suppressing medicines such as methotrexate can increase the response to COVID-19 booster jabs.

Ten Years of Athena Swan in the Medical Sciences Division

2022 marks ten years since the first Athena Swan Bronze applications from the Medical Sciences Division. Ten years later, and all 16 departments in the Division have achieved a Silver Award. We look at NDORMS’ Athena Swan journey.

NDORMS researchers awarded Associate Professor title

The University of Oxford has awarded the title of Associate Professor to Adam Cribbs and Luke Jostins.

Oxford's largest ever study into varicose veins shows need for surgery is linked to genetics

A new international study by Oxford researchers published in Nature Communications, establishes for the first time a critical genetic risk score to predict the likelihood of patients suffering with varicose veins to require surgery, as well as pointing the way towards potential new therapies.

Reflecting on the role of Clinical Director of Trauma and Orthopaedics

In 2021 Professor Andrew Price was appointed Clinical Director of Trauma and Orthopaedics at the Oxford University Hospitals NHS Foundation Trust. After 9 months in post, we find out what the challenges are and what he’s been able to bring to the role.