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Clinical Trial Looking at Most Effective Treatment for Common Hip Fracture in Older Adults

Hip fractures in older adults can lead to serious complications, disability, and even death. Traditionally, orthopedic surgeons have repaired a common fracture of the upper part of the thigh bone, or femur, near the hip using screws and plates to piece together slightly separated pieces of bone. But many surgeons now treat these “minimally displaced” femoral neck fractures by replacing the hip joint with a metal implant.

A new $10.8 million multicenter clinical trial coed by Gerard Slobogean, MD, MPH, an associate professor of orthopedics and director of clinical research in the department of orthopedics at the University of Maryland School of Medicine (UMSOM), will determine if hip replacement surgery, also known as hip arthroplasty, produces better outcomes for patients aged 60 and older than simpler “internal fixation” that has been performed for decades.

“Our goal is to improve patient outcomes after often debilitating hip fractures, especially among older adults,” says Slobogean, who is also an orthopedic trauma surgeon at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (UMMC). “Hip fractures are a major public health concern, and we anticipate that the results of this trial will definitively inform clinical practice, regardless of the result.”

Each year, more than 5 million older adults around the world sustain hip fractures. Femoral neck fractures are very common, and one in five fractures is considered minimally displaced, with only a small gap between the edges of the broken bone. About 14% of those who receive internal fixation surgery ultimately need to have another surgery, such as a hip replacement.

“We want to answer the question, ‘When an older adult has this type of broken hip, does fixing the fracture or replacing the hip best reduce death, maintain their ability to walk, increase their time at home, and improve their overall health?’” Slobogean says. “Currently, we have limited clinical research to help patients, caregivers, and orthopedic surgeons choose the best treatment for each patient.”

Researchers expect to open the randomized controlled clinical trial in the fall. They plan to enroll 600 patients aged 60 or older who need surgery for minimally displaced femoral neck fractures, at 32 tertiary care and community hospitals in the United States, Canada, the United Kingdom, Spain, the Netherlands, and Norway. The R Adams Cowley Shock Trauma Center—the highest-level trauma center in Maryland—will be one of the sites. Patients will be randomly assigned to receive either internal fixation or hip replacement surgery, and investigators will follow them for 12 months.

The FASTER-Hip trial is funded by a $10.8 million grant from the Patient-Centered Outcomes Research Institute (PCORI), awarded to the University of Southern California (USC). UMSOM researchers will receive $2.5 million from this funding. PCORI is an independent nonprofit organization that funds comparative clinical effectiveness research to help patients and clinicians make better-informed health care decisions.

Joseph Patterson, MD, an orthopedic surgeon specializing in fracture care, director of orthopedic trauma research in the department of orthopedic surgery, and assistant professor at the Keck School of Medicine at USC, is the principal investigator. Slobogean and Sheila Sprague, PhD, research director in the department of surgery at McMaster University in Ontario, Canada, are coprincipal investigators.

“Hip fractures among older adults is a significant public health concern, with up to 30 percent of people dying within the first year and others enduring traumatic loss of function and ability to lead productive lives,” says Mark T. Gladwin, MD, the John Z. and Akiko K. Bowers Distinguished Professor and Dean of UMSOM, and vice president for medical affairs at University of Maryland, Baltimore. "Evidence from head-to-head clinical trials will help surgeons advise patients on whether to choose an immediate hip replacement, which is more time-consuming and involves more blood loss, or an internal fixation procedure that may require another surgery later."

— Source: University of Maryland School of Medicine