Evidence
Surveillance decision
We will partially update the guideline on hip fracture: management (NICE guideline CG124), with a focus on section 1.6.
The following table gives an overview of how evidence identified in surveillance might affect each area of the guideline, including any proposed new areas.
|
Section of the guideline |
New evidence identified |
Impact |
|
1.1 Imaging options in occult hip surgery |
No |
No |
|
1.2 Timing of surgery |
Yes |
No |
|
1.3 Analgesia |
Yes |
No |
|
1.4 Anaesthesia |
Yes |
No |
|
1.5 Planning the theatre team |
No |
No |
|
1.6 Surgical procedures |
Yes |
Yes |
|
1.7 Mobilisation strategies |
Yes |
No |
|
1.8 Multidisciplinary management |
Yes |
No |
|
1.9 Patient and carer information |
No |
No |
Reasons for the decision
This section provides a summary of the areas that will be updated and the reasons for the decision to update.
1.6 Surgical procedures
New evidence from a trial conducted in the UK as part of the World Hip Trauma Evaluation Study indicates that Thomson stems may provide similar clinical outcomes to the Exeter/Unitrax stem design. Currently recommendation 1.6.4 suggests using a proven femoral stem design rather than Austin Moore or Thompson stems. During the development of the original guideline no randomised studies were found that compared older stem designs with modern stem designs in patients with hip fractures, thus evidence was extrapolated from studies looking at the selection of prosthesis for primary total hip replacement and expert opinion. Furthermore, surveillance conducted in 2013 and 2015 did not find any studies that addressed this recommendation. As such, this new evidence is directly applicable to addressing a gap in the evidence base that underpins recommendation 1.6.4. An amendment is also proposed for recommendation 1.6.4 to remove mention of the ODEP rating, which is inaccurate.
A suite of Cochrane reviews including surgical procedures for hip fracture is underway and due to publish in October 2020. The WHiTE4 study looking at sliding hip screw versus X-Bolt Dynamic Plating System for trochanteric fractures is also in preparation for publication. These studies could potentially affect several recommendations within section 1.6 and to ensure efficiencies in the update process these studies will be assessed as soon as possible and their impact on section 1.6 will be considered and factored into the update, as needed.
For further details and a summary of all evidence identified in surveillance, see appendix A.
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