HIP ATTACK is the first large randomized study comparing accelerated hip surgery, performed an average of six hours after diagnosis, with the standard, performed an average of 24 hours later. The Lancet echoes their results.
Accelerated hip surgery does not significantly reduce the risk of mortality or serious complications compared to standard surgery. It is the main conclusion of HIP ATTACK, the first large randomized study comparing accelerated hip surgery with standard hip surgery, the results of which have been published in The Lancet. With the participation of 69 hospitals in 17 countries (Canada, Spain, India and Pakistan among them), HIP ATTACK has been carried out based on the observation of a total of 2,970 patients over the age of 45: Vall d’Hebron has been the center with the highest number of patients in the study, since 300 came from the Traumatic Unit of the Orthopaedic Surgery and Traumatology Department.
According to The Lancet magazine, the risk of mortality in patients operated with accelerated hip surgery (1,4876 of the total) and the risk of serious complications (including myocardial infarction, stroke, venous thromboembolic disease, pneumonia, and major or life-threating bleeding) are not reduced within 90 days.
However, operating hip fractures in the first six hours after diagnosis does reduce the risk of delirium, urinary tract infections, moderate to severe pain, and it is associated with faster patient mobilization and a shorter hospital stay compared to standard surgery. “Waiting for a hip fracture operation is undesirable: patients are forced to lie in bed and experience pain or need pain medication, with frequent side effects”, the article in The Lancet says. It adds: “the fact that less than 5% of the chosen patients have refused to participate in the HIP ATTACK study shows that patients want accelerated surgery”.
The HIP ATTACK study also points to the cost savings that accelerated hip surgery can bring compared to standard surgery, as patients can return home a day earlier. According to him, the main cost involved is to enable a supplementary operating room to be able to carry out the surgical operations before the 24 hours of the standard surgery have passed, but it may be offset by the reduction in the time of admission. Based on the data derived from HIP ATTACK, formal economic analysis will be prepared in this regard. The results of the end of the year will also be published, with the complete follow-up of the patients.
“From this first HIP ATTACK experience, the subgroup of patients with acute myocardial damage will be studied later, in which it has been shown that accelerated hip surgery can significantly reduce mortality”, said Dr. Ernesto Guerra, principal investigator of the study and member of the Reconstructive Surgery of the Locomotor System research group at VHIR; and Dr. Joan Minguell, head of the Orthopaedic Surgery and Traumatology Department at Vall d’Hebron and head of the same research group at VHIR.
Even so, both Dr. Minguell and Dr. Guerra highlight the derivatives that emerge from the study, in which Vall d’Hebron has played a leading role. As highlighted in The Lancet article, future research will emphasize strategies to optimize postoperative care for patients who have suffered a hip fracture, an injury that affects 1.5 million adults worldwide each year and that in developed countries it has surgical treatment in 95% of cases.
HEALTH, made in 80 centers in 10 different countries
The New England Journal of Medicine collects another international study, carried out in 80 centers in 10 different countries, in which Vall d’Hebron is the second center that has contributed the most patients. The HEALTH study determines the applicability of total hip arthroplasty compared to hemiarthroplasty in displaced fractures of the femoral neck.
It remains unclear how displaced fractures of the neck of the femur have to be treated surgically in elderly patients. For this reason, this second study compares two surgical procedures for the treatment of these fractures, a hemiarthroplasty and a total hip arthroplasty, in patients older than 50 years.
In hemiarthroplasty the head of the femur is replaced by a prosthesis, while in a total hip arthroplasty the prosthesis replaces both the head of the femur and the acetabulum. The study published in The New England Journal of Medicine concludes that the incidence of 2-year secondary procedures performed on patients does not significantly differ in relation to the type of surgical procedure. However, it determines that total hip arthroplasty provides an improvement over hemiarthroplasty in relation to the functionality and quality of life of the patients at 24 months, despite the fact that it warns that this is not clinically important. 1,495 patients participated in the study. Vall d'Hebron contributed with 121 of them.