HemiSPAiRE (Save Piriformis and Internus, Repair Externus)

Introduction

When someone breaks their hip they often need a partial hip replacement, also known as hemiarthroplasty. To perform this operation surgeons need to cut through some muscles to expose the hip joint and perform the partial replacement. Currently, clinical guidelines suggest that this operation should be performed using a technique which involves cutting muscles and tendons from the side of the hip. This is called the lateral approach. Alternatively, a newer, modified technique can be used leaving all the major muscles intact and this may cause fewer problems for the patient. There is no research evidence to prove which approach is more beneficial. Patients and carers looking for information about this are likely to become confused by the many opinions of surgeons speaking about preferred techniques. It is therefore important to find out which technique is better for patients, based on research rather than opinion.

Project aims

To evaluate the effectiveness of the posterior approach using the SPAIRE technique (where the tendons of piriformis and obturator internus muscles are left intact) compared with the standard lateral approach for patients having hip hemiarthroplasty surgery. The primary outcome is level of function and mobility using the De Morton Mobility Index (DEMMI) test. Secondary outcomes are the Cumulated Ambulation Score (CAS), level of pain using the numeric pain rating scale (NPRS), health-related quality of life (EuroQol EQ-5D), the Oxford Hip Score, acute and total length of stay and specific hip-related complications such as dislocation. Qualitative work examining patient experience of the impact of surgery and recovery period will also be performed.

Anticipated outcome

Improved post-operative function could enable hip fracture patients to regain their previous level of mobility sooner, decreasing the risk of medical problems associated with prolonged recumbence and potentially reducing hospital stay. Such findings will encourage the adoption of a simple modification of a well-established surgical approach familiar to orthopaedic surgeons that could offer patients improved care at no increased cost.

Dissemination will be provided by publications in scientific journals, presentations at National and International Meetings, use of social media networks and the scientific press.

Patient Involvement

The initial premise for this work came from discussions with patients about the importance of function and patients have been and will continue to be involved throughout the Project. Service user and carer Alex Aylward has helped to shape the project aims and protocol and is part of the core trial management group, responsible for the day-to-day running of the project and ensuring patient/carer experience is included in key discussions.

Older adults, including care home residents have been involved in designing the patient-facing documents for the study, and making sure the recruitment and consent processes are acceptable.

We will continue to involve patients throughout the project, especially when it comes to thinking about the implications of the results from this project and making sure results are seen by those patients and their carers.