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Hemiarthroplasty or Total Hip Arthroplasty for Independently Mobile Older Adults with an Intracapsular Hip Fracture (the HoT study).

Project Summary

There are 70,000 hip fractures every year in the United Kingdom. Many patients are treated with a joint replacement: total hip arthroplasty (THA) in which both femoral head and acetabulum are replaced or hemiarthroplasty (HA) in which only the femoral head is replaced. The National Institute for Health and Clinical Excellence (NICE) recommends that THA should be considered for patients that are independently mobile, cognitively intact, and are medically fit for the procedure.

In this study, researchers will link data from the National Hip Fracture Database (NHFD), Hospital Episode Statistics (HES), and the Civil Registration Database (CRD). They will use statistical techniques to ask whether (1) THA is associated with better outcomes than HA for patients satisfying the NICE criteria and (2) whether compliance with NICE guidance is associated with complications, re-operation, length of stay, discharge destination, and death.

Research Team

The researchers leading this project are Matthew Costa (Professor of Orthopaedic Trauma Surgery), Daniel Perry (Associate Professor of Orthopaedic Trauma Surgery), and David Metcalfe (Clinical Research Fellow in Musculoskeletal Trauma).

Data Flows

Data within the National Hip Fracture Database (NHFD) will be linked to records held by NHS Digital as part of Hospital Episode Statistics (HES) and the Civil Registration Database (CRD). The University of Oxford will be the Data Controller for the linked NHFD-HES-CRD dataset.

The diagram below describes the flow of patient data. In summary, individual NHS trusts send patient-identifiable information to the Falls and Fragility Fracture Audit Programme (FFFAP, which is run by the Royal College of Physicians [RCP] on behalf of the Healthcare Quality Improvement Programme [HQIP]) to populate the National Hip Fracture Database (NHFD). The NHFD data is processed by Crown Informatics Ltd on behalf of the FFFAP.  Crown Informatics will send limited patient-identifiable data (including NHS number, date of birth, full postcode, gender, injury date, and a unique FFFAP ID) to NHS Digital. NHS Digital in turn will match the NHFD records to patients’ HES and CRD data before returning these (together with the FFFAP ID but without the other sensitive fields, e.g. NHS number) to Crown Informatics.