Does osteoarthritis of the hip make failure of internal fixation more likely? A comparison of all hip fractures, comparing the presence of osteoarthritis to rates of failure.

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Aim: The aim of this study is to determine whether a diagnosis of osteoarthritis (OA) in the hip, makes failure of internal fixation in hip fractures more likely; in the patient population group undergoing internal fixation for proximal femoral fractures at any Western Australian tertiary hospital between 2002-2004. Importance: Hip fractures are very common in Australia and are associated with high mortality and morbidity. The number of hip fractures in Australian women is projected to increase from 11 300 per year in 1996 to 44 700 in 2051; In men, the number is projected to rise from 4 000 to 15 300. The cost of this clinical problem is estimated at between 0.9-1.4% of the total government healthcare expenditure. Most will be managed with surgery, through internal fixation. This process can fail (failure of internal fixation). Many of the patient factors behind failure of fixation are unknown. Through clinical observation it is assumed that OA does increase the likelihood of fixation failure, however no published research exists to support this assumption. The reasons behind why OA may have this effect relates to alterations in bone homeostasis. Given that OA is highly prevalent in our society it is important to determine if a link exists between hip OA and failure of fixation. If a link is established, this information would assist clinicians in the choice of an appropriate fixation technique and reduce the likelihood of failure and therefore reoperation. This information would contribute to an improved efficiency of health care provision in this patient group. In addition, it would serve to use the limited health dollar more efficaciously. Methods: This is a multi-centred study in which data will be collected retrospectively, investigating an estimated 700-800 patients records, across the three tertiary hospitals in Western Australia, where internal fixation was performed after hip fracture. This sample size will allow study estimates to be representative of the population estimate. The presence of OA at time of fracture will be identified. Failure of internal fixation will be identified over a four year follow-up period. The collected data will be analysed using a Proportional Hazard Regression model (Cox Regression model) to measure rates of failure of fixation between two patient groups: the patient group with no hip OA and the patient group with hip OA. Benefits: The median cost for hospital treated proximal femoral fractures is approximately $15,984 per fracture. Reducing the number of fixation failures would therefore result in measurable reductions to health care budget expenditure, in combination with the reduction in mortality and morbidity associated with reoperation.

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