Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Aaron Nauth; Aaron T. Creek; Abby Zellar; Abdel Rahman Lawendy; Adam Dowrick; Ajay Gupta; Akhil Dadi; Albert van Kampen; Albert Yee; Alexander C. de Vries; Alexander de Mol van Otterloo; Alisha Garibaldi; Allen Liew; Allison W. McIntyre; Amal Shankar Prasad; Amanda W. Romero; Amar Rangan; Amber Oatt; Amir Sanghavi; Amy L. Foley; Anders Karlsten; Andrea Dolenc; Andrew Bucknill; Andrew Chia; Andrew Evans; Andrew Gong; Andrew H. Schmidt; Andrew J. Marcantonio; Andrew Jennings; Angela Ward; Angshuman Khanna; Anil Rai; Anke B. Smits; Annamarie D. Horan; Anne Christine Brekke; Annette Flynn; Aravin Duraikannan; Are Stødle; Arie B. van Vugt; Arlene Luther; Arthur W. Zurcher; Arvind Jain; Asgeir Amundsen; Ash Moaveni; Ashley Carr; Julie A. Switzer; Marc Swiontkowski; Paul M. Lafferty; Peter A. Cole; Sarah A Anderson; Scott B. Marston; Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators

doi:10.1016/S0140-6736(17)30066-1

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Aaron Nauth, Aaron T. Creek, Abby Zellar, Abdel Rahman Lawendy, Adam Dowrick, Ajay Gupta, Akhil Dadi, Albert van Kampen, Albert Yee, Alexander C. de Vries, Alexander de Mol van Otterloo, Alisha Garibaldi, Allen Liew, Allison W. McIntyre, Amal Shankar Prasad, Amanda W. Romero, Amar Rangan, Amber Oatt, Amir Sanghavi, Amy L. FoleyAnders Karlsten, Andrea Dolenc, Andrew Bucknill, Andrew Chia, Andrew Evans, Andrew Gong, Andrew H. Schmidt, Andrew J. Marcantonio, Andrew Jennings, Angela Ward, Angshuman Khanna, Anil Rai, Anke B. Smits, Annamarie D. Horan, Anne Christine Brekke, Annette Flynn, Aravin Duraikannan, Are Stødle, Arie B. van Vugt, Arlene Luther, Arthur W. Zurcher, Arvind Jain, Asgeir Amundsen, Ash Moaveni, Ashley Carr, Julie A. Switzer, Marc Swiontkowski, Paul M. Lafferty, Peter A. Cole, Sarah A Anderson, Scott B. Marston, Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

209 Scopus citations

Abstract

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.

Original language	English (US)
Pages (from-to)	1519-1527
Number of pages	9
Journal	The Lancet
Volume	389
Issue number	10078
DOIs	https://doi.org/10.1016/S0140-6736(17)30066-1
State	Published - Apr 15 2017

Bibliographical note

Funding Information:
This study was funded by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), The Netherlands Organisation for Health Research and Development (80-82310-97-11032), Physicians' Services Incorporated, and Stryker GmBH. MB was also funded, in part, through the Early Research Award Program, which provided funding for the present study, and by a Canada research chair in musculoskeletal trauma, which is unrelated to the present study (McMaster University, Hamilton, ON, Canada). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham & Tees Valley Comprehensive Local Research Network, which operates as part of the National Institute for Health Research Comprehensive Clinical Research Network in England.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597430

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Nauth, A., Creek, A. T., Zellar, A., Lawendy, A. R., Dowrick, A., Gupta, A., Dadi, A., van Kampen, A., Yee, A., de Vries, A. C., de Mol van Otterloo, A., Garibaldi, A., Liew, A., McIntyre, A. W., Prasad, A. S., Romero, A. W., Rangan, A., Oatt, A., Sanghavi, A., ... Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators (2017). Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. The Lancet, 389(10078), 1519-1527. https://doi.org/10.1016/S0140-6736(17)30066-1

Nauth, A, Creek, AT, Zellar, A, Lawendy, AR, Dowrick, A, Gupta, A, Dadi, A, van Kampen, A, Yee, A, de Vries, AC, de Mol van Otterloo, A, Garibaldi, A, Liew, A, McIntyre, AW, Prasad, AS, Romero, AW, Rangan, A, Oatt, A, Sanghavi, A, Foley, AL, Karlsten, A, Dolenc, A, Bucknill, A, Chia, A, Evans, A, Gong, A, Schmidt, AH, Marcantonio, AJ, Jennings, A, Ward, A, Khanna, A, Rai, A, Smits, AB, Horan, AD, Brekke, AC, Flynn, A, Duraikannan, A, Stødle, A, van Vugt, AB, Luther, A, Zurcher, AW, Jain, A, Amundsen, A, Moaveni, A, Carr, A, Switzer, JA, Swiontkowski, M , Lafferty, PM , Cole, PA , Anderson, SA , Marston, SB & Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators 2017, 'Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial', The Lancet, vol. 389, no. 10078, pp. 1519-1527. https://doi.org/10.1016/S0140-6736(17)30066-1

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title = "Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial",

abstract = "Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.",

author = "Aaron Nauth and Creek, {Aaron T.} and Abby Zellar and Lawendy, {Abdel Rahman} and Adam Dowrick and Ajay Gupta and Akhil Dadi and {van Kampen}, Albert and Albert Yee and {de Vries}, {Alexander C.} and {de Mol van Otterloo}, Alexander and Alisha Garibaldi and Allen Liew and McIntyre, {Allison W.} and Prasad, {Amal Shankar} and Romero, {Amanda W.} and Amar Rangan and Amber Oatt and Amir Sanghavi and Foley, {Amy L.} and Anders Karlsten and Andrea Dolenc and Andrew Bucknill and Andrew Chia and Andrew Evans and Andrew Gong and Schmidt, {Andrew H.} and Marcantonio, {Andrew J.} and Andrew Jennings and Angela Ward and Angshuman Khanna and Anil Rai and Smits, {Anke B.} and Horan, {Annamarie D.} and Brekke, {Anne Christine} and Annette Flynn and Aravin Duraikannan and Are St{\o}dle and {van Vugt}, {Arie B.} and Arlene Luther and Zurcher, {Arthur W.} and Arvind Jain and Asgeir Amundsen and Ash Moaveni and Ashley Carr and Switzer, {Julie A.} and Marc Swiontkowski and Lafferty, {Paul M.} and Cole, {Peter A.} and Anderson, {Sarah A} and Marston, {Scott B.} and {Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators}",

note = "Funding Information: This study was funded by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), The Netherlands Organisation for Health Research and Development (80-82310-97-11032), Physicians' Services Incorporated, and Stryker GmBH. MB was also funded, in part, through the Early Research Award Program, which provided funding for the present study, and by a Canada research chair in musculoskeletal trauma, which is unrelated to the present study (McMaster University, Hamilton, ON, Canada). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham & Tees Valley Comprehensive Local Research Network, which operates as part of the National Institute for Health Research Comprehensive Clinical Research Network in England.",

year = "2017",

month = apr,

day = "15",

doi = "10.1016/S0140-6736(17)30066-1",

language = "English (US)",

volume = "389",

pages = "1519--1527",

journal = "The Lancet",

issn = "0140-6736",

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number = "10078",

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TY - JOUR

T1 - Fracture fixation in the operative management of hip fractures (FAITH)

T2 - an international, multicentre, randomised controlled trial

AU - Nauth, Aaron

AU - Creek, Aaron T.

AU - Zellar, Abby

AU - Lawendy, Abdel Rahman

AU - Dowrick, Adam

AU - Gupta, Ajay

AU - Dadi, Akhil

AU - van Kampen, Albert

AU - Yee, Albert

AU - de Vries, Alexander C.

AU - de Mol van Otterloo, Alexander

AU - Garibaldi, Alisha

AU - Liew, Allen

AU - McIntyre, Allison W.

AU - Prasad, Amal Shankar

AU - Romero, Amanda W.

AU - Rangan, Amar

AU - Oatt, Amber

AU - Sanghavi, Amir

AU - Foley, Amy L.

AU - Karlsten, Anders

AU - Dolenc, Andrea

AU - Bucknill, Andrew

AU - Chia, Andrew

AU - Evans, Andrew

AU - Gong, Andrew

AU - Schmidt, Andrew H.

AU - Marcantonio, Andrew J.

AU - Jennings, Andrew

AU - Ward, Angela

AU - Khanna, Angshuman

AU - Rai, Anil

AU - Smits, Anke B.

AU - Horan, Annamarie D.

AU - Brekke, Anne Christine

AU - Flynn, Annette

AU - Duraikannan, Aravin

AU - Stødle, Are

AU - van Vugt, Arie B.

AU - Luther, Arlene

AU - Zurcher, Arthur W.

AU - Jain, Arvind

AU - Amundsen, Asgeir

AU - Moaveni, Ash

AU - Carr, Ashley

AU - Switzer, Julie A.

AU - Swiontkowski, Marc

AU - Lafferty, Paul M.

AU - Cole, Peter A.

AU - Anderson, Sarah A

AU - Marston, Scott B.

AU - Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators

N1 - Funding Information: This study was funded by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), The Netherlands Organisation for Health Research and Development (80-82310-97-11032), Physicians' Services Incorporated, and Stryker GmBH. MB was also funded, in part, through the Early Research Award Program, which provided funding for the present study, and by a Canada research chair in musculoskeletal trauma, which is unrelated to the present study (McMaster University, Hamilton, ON, Canada). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham & Tees Valley Comprehensive Local Research Network, which operates as part of the National Institute for Health Research Comprehensive Clinical Research Network in England.

PY - 2017/4/15

Y1 - 2017/4/15

N2 - Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.

AB - Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.

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JF - The Lancet

IS - 10078

ER -

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

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