The PROFOUND study

This £1.3m study has been funded by the National Institute for Health and Social Care and will last until November 2025. It’s led by Alex Bottle at Imperial College London and involves a large team from across England from different professional disciplines.

What is the problem?

Due to arthritis, many people, especially those aged over 65, need their hip or knee replaced. Every year in the UK, over 200,000 people have such a joint replacement, usually with a good result. However, at some time after the operation, the person may fall and break the bone around their artificial hip or knee (prosthesis). This is known as a periprosthetic fracture. These fractures are difficult and costly to treat, and there are differences in opinion on how best to do so. We also have limited information on how these differences affect important outcomes such as mobility and death. Our study aims to fill in these key gaps in knowledge.

What are we doing?

We will use a combination of statistical analyses of four national databases and interviews and surveys with staff, patients and their families. The four databases will tell us a lot about how much variation there is in how these cases are managed, from how patients are monitored following admission to hospital to what types of prostheses are used to fix the break, and about variation in the end result. We are also interested in the effect of transferring patients from one hospital to another, as this too varies around the country. The interviews and surveys will be part of six case studies involving site visits to hospitals that manage these cases in different ways. For instance, some transfer all cases to another hospital, whereas others treat them all in-house. We want to know what staff and patients think good care should look like, including whether patients would be willing to travel further to a more specialised centre.

How are we doing it?

The four databases that we will analyse are called Hospital Episodes Statistics, the National Hip Fracture Database, the Trauma and Audit Research Network, and the National Joint Registry. Each contains patient-level data (no names or addresses) with appropriate ethical approvals in place. This statistical analysis is the quantitative part of the study. The qualitative part, led by Jon Benn and Cliff Shelton, will consist of site visits to six hospitals, with interviews with staff, patients and carers and analysis of policy documents. We will also seek consensus (using a method called a Delphi study) about how the quality of care for patients with these fractures should be measured. Lastly, with the help of our public partners, we will produce resources such as paper and online patient leaflets to help patients know what to expect from their treatment if they have one of these fractures.

Fair processing notice (how we use your data): this document FPN (doc) describes how we are processing the patient data for this study and how to find out more about them. In brief, in this project, patient-identifiable data such as names and NHS numbers are only used to link records from the National Hip Fracture Database to the national death register in order to determine when someone died. The use of this information for this specific purpose is being considered by the Confidential Advisory Group. The patient-identifiable data will be removed after linkage and not given to us, as we do not need it for our analysis.

For more information, please contact Professor Alex Bottle.

Project updates

In September 2024, Dr Walter Muruet joined the team as a research assistant to anaylse our quantitative data alongside post-doc Dr Mohammad Aryaie. The full project team met in our new building in White City in October. The qual team is making contact with our first case study hospitals to set up the interviews. The oversight committee, chaired by Prof Iain Moppett, aims to hold its second meeting before year end.

Dissemination activities

1) We announced the project to the British Hip Society early in 2023 at a session dedicated to periprosthetic fractures.

2) Two posters at HSRUK's annual conference in Oxford in Jul 2024: HSRUK2024 - "In search of best practice for Periprosthetic Femoral Fracture Care: A qualitative study of expert perspectives on variations in service delivery" and "Variability in the management of periprosthetic femoral fractures between hospitals in England"

3) A talk at EASST/4S Joint Annual Conference (16-19 July 2024, Amsterdam): "Standardising Periprosthetic Fracture Care? Exploring frictions in the making – or unmaking – of a new sub-specialism"

4) A talk at the Association of Anaesthetists Seminar on Hip Fracture (15 Oct 2024, London): "Periprosthetic femoral fractures and the PROFOUND study"

Several HES-based papers are in progress, with one under review at a journal.