The University of Southern California (USC) has been granted $10.8 million by the Patient-Centered Outcomes Research Institute (PCORI) to lead a groundbreaking study focused on comparing hip fracture surgery options in older adults. The research, spearheaded by orthopedic surgeon Dr. Joseph Patterson, is titled the “FASTER-Hip” trial and seeks to determine the best surgical approach for patients with a specific type of hip fracture known as femoral neck fractures. This study aims to compare the outcomes of hip replacement surgery versus a less invasive procedure called internal fixation, ultimately determining which approach provides the most beneficial results for older adults.

The Need for the Study: Understanding Hip Fractures and Their Risks

Hip fractures in older adults are a significant global health issue, with over 5 million individuals suffering from them each year. The consequences of hip fractures can be severe, ranging from permanent disability to death, and the medical community has long debated the optimal approach to treatment. One common type of hip fracture is a femoral neck fracture, where the bone in the upper thigh breaks but the pieces remain in relatively close contact or only slightly displaced. These fractures are often treated with internal fixation, a procedure that uses screws and plates to stabilize the bone while it heals. However, recent data suggests that up to 14% of patients who undergo internal fixation will require additional surgeries, such as a hip replacement, due to complications or insufficient healing.

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Dr. Joseph Patterson, the principal investigator for the FASTER-Hip trial, explains that while internal fixation is a less invasive surgery with fewer risks, it is not always successful in the long term. On the other hand, hip replacement surgery, while a more complicated procedure, might provide better outcomes in the long run, despite the higher initial risks and complications associated with it. “Our goal is to understand if starting with the more extensive hip replacement surgery leads to better long-term outcomes for these patients,” Patterson said.

The FASTER-Hip Trial: A Focus on Patient-Centered Research

The FASTER-Hip trial will enroll 600 patients aged 60 and older, from clinical sites across the United States, Canada, and Europe. The study will compare the outcomes of hip replacement surgery and internal fixation, monitoring a range of health metrics, including patient survival, the need for additional surgeries, and complications. However, what sets this study apart is its patient-centered approach, emphasizing the outcomes that matter most to patients, caregivers, and the broader healthcare community.

While most clinical trials focus on outcomes that are important to healthcare systems and insurers, such as mortality rates and hospital readmissions, the FASTER-Hip trial takes a more holistic approach. The research team has worked closely with a diverse group of patient stakeholders, including patients, their families, geriatricians, rehabilitation professionals, and insurance representatives. Together, they ensure that the data collected reflects the experiences and priorities of the people most affected by these surgeries. “We want to understand not just whether patients survive and avoid additional surgeries, but also whether they regain the ability to walk, live independently, and return home after surgery,” Patterson emphasized.

The importance of these outcomes cannot be overstated, as many older adults place a high value on maintaining their independence and mobility. In fact, regaining the ability to walk and returning home are often more important to patients than simply surviving the surgery or avoiding a second operation. These insights have been made possible through ongoing engagement with patients and their caregivers, which has informed the design of the trial and the selection of relevant outcomes.

Collaborating with Experts Across Multiple Institutions

The trial will be conducted under the leadership of Dr. Patterson, with the support of co-principal investigators Dr. Gerard Slobogean from the University of Maryland School of Medicine and Dr. Sheila Sprague from McMaster University in Ontario, Canada. Together, these experts bring a wealth of experience in orthopedic research and patient-centered outcomes. Dr. Slobogean will oversee patient engagement and protocol development, while Dr. Sprague will manage the trial’s methods center and infrastructure.

The collaboration between institutions in the United States, Canada, and Europe ensures that the trial will encompass a diverse patient population, providing more comprehensive and generalized results. The study’s international scope allows for comparisons across different healthcare systems and cultural contexts, further enriching the findings.

Informing Clinical Guidelines and Best Practices

The ultimate goal of the FASTER-Hip trial is to provide evidence that can inform clinical guidelines and medical practice. By comparing the two surgical approaches, the research team hopes to develop recommendations that will help clinicians, patients, and caregivers make better-informed decisions about hip fracture treatment. These guidelines will be based on data that reflects not just clinical outcomes but also the personal preferences and priorities of patients.

As orthopedic trauma and hip fracture treatment continue to evolve, clinical guidelines must adapt based on new evidence. Leading organizations, including the Orthopaedic Trauma Association, the American Academy of Orthopaedic Surgeons, and the American Association of Hip and Knee Surgeons, have expressed support for the FASTER-Hip trial, recognizing the importance of patient-centered comparative effectiveness research.

“This research has the potential to change how hip fractures are treated in older adults,” said Patterson. “By providing clinicians with the evidence they need, we can ensure that patients receive the type of care that aligns with their goals and values.”

The Potential Impact of the Study

If the FASTER-Hip trial successfully demonstrates that one approach—hip replacement or internal fixation—is superior to the other in terms of patient outcomes, it could revolutionize how hip fractures are treated in older adults. The study could lead to changes in clinical practice, shifting the preference toward the more effective surgical option and improving patient outcomes across the board.

Moreover, the patient-centered approach to the trial ensures that the research will address real-world concerns that are often overlooked in traditional clinical trials. By focusing on what matters most to patients—such as the ability to walk, live independently, and avoid further surgery—the study could influence not only clinical practices but also policy decisions related to healthcare funding and access to treatment.

A Step Forward in Orthopedic Research

The FASTER-Hip trial represents a significant advancement in the field of orthopedic surgery, particularly for older adults facing hip fractures. With a focus on patient-centered outcomes and collaboration between experts from around the world, the study has the potential to provide valuable insights that will inform clinical practice for years to come.

As hip fractures continue to affect millions of older adults globally, understanding the most effective treatment options is crucial. By conducting this research, the USC-led team hopes to provide patients and clinicians with the information they need to make the best decisions for their health and well-being. With $10.8 million in funding from PCORI and a dedicated research team, the FASTER-Hip trial is poised to make a lasting impact on the field of orthopedic trauma and fracture care.