Typically hip operations have been associated with old age, where arthritis and osteoporosis lead to crumbling or fracturing bones. However, thanks to the great improvements in the quality of prosthetics and techniques over the past few decades, more people are maximizing the benefits of a new hip by having surgery earlier. According to the Royal College of Surgeons, the number of operations increased across all age groups from 89,919 in 2004-5 to 122,154 in 2014-15.

 

Cost of infection


But alongside younger patients, an aging population means more people are also being admitted for emergency surgery following hip fractures. It’s this group of patients that Mr Matthew Porteous, Consultant Trauma and Orthopedic Surgeon at West Suffolk NHS Foundation Trust, believes are at greatest risk.

“The risk of infection for an elective hip operation is less than 0.5 per cent. For emergency operations we’re looking at around 1.5-5 per cent,” he says. “Ideally you want to prepare someone correctly for surgery. But for patients with a fracture, all the evidence shows that the quicker you operate, the better the outcome. So you have to get on and do it with all the risks involved.”

If infection sets in the consequences could be dire. The hip will need to be removed and the infection treated before the hip can be re-replaced some six to twelve weeks later. This will treble the costs to more than £30,000 and place the patient at even greater risk, cause a long stay in hospital and an increase in patient mortality.

 

Focus on prevention


In the early days of hip surgery, infection rates were as high as 10 per cent. The introduction of antibiotic cement and other initiatives in the 70s and 80s saw this figure start to fall. “In the 1990s and 2000s a series of studies from the hip registry in Scandinavia showed that using antibiotic cement to fix the prosthetic components was one effective way to reduce infection,” says Mr Porteous. “It’s so much better to prevent than manage infection and the latest research suggests that using a combination of antibiotics could be a very effective approach, particularly in patients with femoral neck fractures.”

Alongside the use of antibiotic cement, improved anesthetic techniques and after care have helped to halve mortality rates in the last decade and ensure patients return home quicker and in a much better state of health. The challenge will be maintaining progress as demand increases.