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.

Older patients with hip fractures recover better if they receive treatment under the supervision of both a surgeon and a specialist in elderly care; are checked to avoid future falls; and are assessed for memory problems.

In the UK, the National Health Service (NHS) has set standards for hip fracture care which identify seven indicators that doctors and healthcare providers are recommended to provide to improve patient outcomes and quality of life.

“These performance indicators are part of the UK NHS Best Practice Tariff (BPT) where providers are reimbursed based on the care delivered in the period following injury,” said Matthew Costa, Professor of Orthopaedic Trauma Surgery at NDORMS.  “But it’s not clear whether the tariff is associated directly with improved patient outcomes or really how much difference each aspect of care makes to a person’s recovery. Through the WHiTE study we could test the seven recommendations to see which had the greatest impact and whether some should be prioritised by hospitals.”

A broken hip is the most common type of injury in older people and can have a devastating impact on pain and mobility, with a long-term reduction in a patient’s quality of life. The World Hip Trauma Evaluation (WHiTE) study was set up in 2014, recruiting patients with hip fractures from 20 NHS hospitals in England to report on health-related quality of life outcomes. Judged to be the most important outcome following this type of injury, Prof. Costa and Prof Griffin’s team could measure the effectiveness of clinical care provided against patients’ quality of life, and from there which elements of best care lead to the most improvement.  

Published in the Bone and Joint Journal, the study looked at more than 8,000 patients aged 60 years and older who had been operated on for a broken hip. Patients received follow up at 4 months to report on their quality of life. The researchers reviewed the treatment patients received against the seven indicators. Around half of patients received all seven recommended aspects of care and they recovered best.

The analysis showed that each of the seven aspects of care contributed to recovery but three stood out as most effective. 

  • Admission under the joint care of a consultant surgeon and a specialist in the care of older people
  • Checks to avoid falls and assess bone health
  • Checks for memory problems before and after surgery

“This study is also the first to show that tariff payments linked to the delivery of recommendations for best care lead to better quality of life for patients”. Professor Costa added: “In an ideal situation patients would receive all seven recommended care treatments and make the best recovery. Where this is not possible we would recommend that hospitals prioritise these three aspects that we have shown to have the greatest impact in improving quality of life following a hip fracture.”  

The WHiTE study is funded by the National Institute for Health Research and the NIHR Oxford Biomedical Research Centre, and supported by the UK Musculoskeletal Trauma Patient and Public Involvement Group.

The WHiTE study is also being used to test new treatments for patients. Current clinical trials include studies looking at surgical devices, new treatments to reduce infection, treatments to reduce confusion after surgery and to speed patients’ recovery.

Similar stories

Patient and public involvement in Rheumatology research – embracing the wave of change

On launching the new OPEN ARMS PPI group in Oxford, Dr. Laura Coates explored the patient and public involvement (PPI) models of three academic centres in the UK to show how it benefits researchers, clinicians, and patients alike.

Neutrophil molecular wiring revealed: transcriptional blueprint of short-lived cells

Researchers publish the first blueprint of transcriptional factors that control neutrophil-driven inflammation in Nature Immunology.

NDORMS joins research partnership to understand links between overlapping long-term conditions

The links between different long-term health conditions will be explored in new research funded with a £2.5million grant from the Medical Research Council.

NDORMS researchers awarded grant for study on the effects of COVID-19 vaccines on long COVID

A team of NDORMS researchers including Doctor Annika Jödicke and Doctor Victoria Strauss have been awarded NIHR funding to carry out a study into the effects of different COVID-19 vaccines on long COVID.

New therapeutic targets identified in the treatment of psoriatic arthritis

Researchers identify two inflammatory-driving proteins, osteopontin and CCL2, highly expressed in psoriatic arthritis joints.

Researchers show the role of cilia in cartilage health

New research shows that disrupting primary cilia in juvenile, adolescent and early adulthood in cartilage stops it maturing correctly, making it more prone to thinning and the potential for osteoarthritis (OA) in later life.