Orthopaedic surgeons prefer new expensive technology for treatment of hip fractures: An international survey on the surgical practices

Background: The health care expenditures for the management of hip fractures are growing along with the rise in their prevalence. The ideal method of surgical treatment for hip fractures is controversial. The present survey aimed to determine the current international practices of the management of these fractures and to compare the findings with the available evidence. Methods: We distributed questionnaires to orthopaedic surgeons at the Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS) 2011 and the 12th meeting of the European Federation of National Associations of Orthopaedics and Traumatology (EFFORT). The following questions were asked: (1) In a displaced intracapsular hip fracture in an elderly patient, what is your treatment of choice? (2) In 31A1 and 31A2 hip fractures, what is your preferable implant for fixation? Results: The total number of responders was 291 from 57 countries. For the first question, 47% of the responders chose bipolar arthroplasty, 32% unipolar, 14% total hip replacement, and 7% open reduction internal fixation. For the second question 51% chose dynamic hip screw, 46% preferred an intramedullary device, and 3% chose other treatment modality. For both questions these choices were not influenced significantly by geographic origin, area of specialty, or the seniority status (P=0.25). Conclusions: While the common practice in the surgical treatment choice for intracapsular fracture of the elderly is not evidence based, the surgeons' preferences are consistent with available evidence in the choice of surgical treatment for extracapsular hip fractures. The popularity of intramedullary devices for intertrochanteric fractures and bipolar hemiarthroplasties for intracapsular fractures is unjustified in light of their high relative costs.