Strict adherence to evidence-based protocol in choice of implants and surgical technique leads to fewer hip fracture reoperations

Elvira R. Flikweert*, Ronald L. Diercks, Gerbrand J. Izaks, Klaus W. Wendt, Martin Stevens, Inge H. F. Reininga

*Corresponding author for this work

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Background and purpose

Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation. Only part of the complications are surgery-related, however these, including reoperation may have the highest impact. Operative protocols are designed to treat all patients equally, according to evidence based guidelines. Aim of this study was to investigate the association between strict adherence to an operative protocol and postoperative complications, especially reoperations.

Materials and methods

A retrospective analyses of a prospective cohort. The cohort included all patients aged >= 60 treated fora hip fracture at University Medical Center Groningen between July 2009 and June 2013. The files of the patients were searched for complications, including reoperations. To evaluate adherence to the operative protocol all X-rays were retrospectively reviewed and the fracture type was reclassified. This retrospective fracture classification was compared with the treatment method used. Logistic regression analyses were used to assess whether patients that were not treated strictly according to the operative protocol have higher odds of developing a complication or of undergoing a reoperation.


The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years. Reoperation was performed in 11% of the patients during the follow-up period. The operative protocol was not followed strictly in 12% of the patients. When the operative protocol was not followed, the odds of having a reoperation was 2.41 times higher (p = 0.02). The overall complication rate was 75% and did not differ in both groups.


Strict adherence to an evidence-based operative protocol is of major importance toward preventing implant-related problems and reoperations

Original languageEnglish
Article numbere0210239
Number of pages9
JournalPLoS ONE
Issue number1
Publication statusPublished - 7-Jan-2019



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