A groundbreaking multi-center study led by the University of Southern California (USC) will investigate optimal surgical approaches for treating hip fractures in older adults, supported by a $10.8 million grant from the Patient-Centered Outcomes Research Institute (PCORI).
The FASTER-Hip trial, spearheaded by Dr. Joseph Patterson of Keck Medicine of USC, aims to resolve a critical debate in orthopedic surgery: whether patients with minimally displaced femoral neck fractures achieve better outcomes with total hip replacement or internal fixation procedures.
"Surgeons have strong feelings about these two procedures," explains Dr. Patterson, director of orthopedic trauma research at USC. "We want to know what the evidence shows. Is starting with the larger surgery better for these patients?"
Global Impact and Clinical Significance
Hip fractures affect over 5 million older adults globally each year, with minimally displaced femoral neck fractures representing a significant subset. These fractures occur when the femur's neck breaks but the bone fragments remain closely aligned or only slightly separated.
Currently, internal fixation—using metal screws and plates to stabilize the bone—is the predominant treatment approach. While this procedure is less invasive and carries lower risks of certain complications, recent data shows that 14% of patients eventually require additional surgery.
Study Design and International Collaboration
The trial will enroll 600 patients aged 60 and older across 32 clinical sites throughout the United States, Canada, and Europe. The research team includes co-principal investigators Dr. Gerard Slobogean from the University of Maryland School of Medicine and Dr. Sheila Sprague from McMaster University.
Patient-Centered Approach
What sets this study apart is its emphasis on outcomes that matter most to patients rather than traditional surgical metrics. The research team has assembled a diverse stakeholder group including:
- Patients and family members
- Geriatricians
- Rehabilitation professionals
- Insurance company representatives
- Professional society members
"Already, our engagement with patients and their caregivers has revealed outcomes that matter to them, outcomes which differ from the ones we tend to think about as surgeons and epidemiologists," notes Dr. Patterson. Beyond survival rates and reoperation statistics, patients prioritize maintaining independence, returning home, and regaining mobility.
Clinical Practice Implications
The study's findings could significantly influence clinical guidelines used by major orthopedic organizations, including the Orthopaedic Trauma Association and the American Academy of Orthopaedic Surgeons. These results will help surgeons provide more personalized treatment recommendations based on individual patient priorities and goals.
"Our goal is to generate the evidence that surgeons around the world can use to have conversations with patients and their family members about how best to achieve their goals," Dr. Patterson emphasizes.
The trial represents a significant step forward in evidence-based orthopedic care, promising to deliver data that will help both healthcare providers and patients make more informed decisions about hip fracture treatment approaches.
