Hip fracture: management

Search and selection strategy

We searched for new evidence related to the whole guideline.

We found 62 studies in a search for randomised controlled trials (RCTs) and systematic reviews published between 2 February 2015 and 31 May 2019. There were 89 studies identified by searches in previous surveillance in 2013 and 2015. There were also 2 trials identified by stakeholders.

From all sources, we considered 153 studies to be relevant to the guideline.

See appendix A for details of all evidence considered, and references.

Views of topic experts

We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.

We sent questionnaires to 11 topic experts and received 2 responses. The topic experts had expertise in geriatric medicine and general practice. One expert did not think the NICE guideline should be updated. One expert suggested that the NICE guideline should be updated and highlighted that the management of hip fracture in older people SIGN guideline (2009) is proposed to be updated (currently on hold).

Implementation of the guideline

Uptake data from 2017/2018 indicates that the uptake of recommendations has been variable. Some of the well implemented recommendations are as follows: the proportion of arthroplasties which are cemented was 91.4% in 2018 (recommendation 1.6.5); the proportion of intramedullary nails used for subtrochanteric fractures was 89.3% in 2018 (recommendation 1.6.8); and the proportion of people with hip fracture who are mobilised out of bed the day after surgery was 73.3% (recommendation 1.7.1). The following recommendations were less well implemented: the proportion of people with displaced intracapsular fractures treated with total hip replacement if clinically eligible was 33.5% in 2018 (recommendation 1.6.3); the proportion of patients who had their pain re-evaluated during admission on the emergency department was 40% in 2017 (recommendation 1.3.1); and the proportion of emergency departments that have written information about hip fracture available for patient and/or their relatives and carers was 25% in 2017 (recommendation 1.9.1).

Other sources of information

We considered all other correspondence received since the guideline was published. These included external communications from health care professionals and external organisations received before and during this surveillance review.

Views of stakeholders

Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because this surveillance proposal was to update recommendation 1.6.4, we consulted with stakeholders.

Overall, 10 stakeholders commented. Stakeholders covered a range of relevant organisations including The Royal Osteoporosis Society, Royal College of Nursing, NHS England, Public Health England, and the Bone Joint and Muscle Trauma Cochrane Group. Five stakeholders agreed with the proposal to partially update the guideline with a focus on the areas described above. Three stakeholders did not provide a clear response, and 2 disagreed. One disagreed on the basis of an increase in hip fractures but did not provide further detail of how this would impact the guideline. The second stakeholder disagreed and felt recommendation 1.6.7 (covering extramedullary implants) should be updated and submitted additional evidence, which was considered for inclusion in the surveillance review. Two additional studies were included but did not impact the final surveillance decision.

See appendix B for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.