Development of safe, affordable, and holistic hip fracture care for the elderly in China

Femoral neck fracture, a type of hip fracture, is a common and severely debilitating injury in the elderly that usually occurs after a fall and significantly increases mortality. These injuries are ideally treated with surgery, often with a partial hip replacement (hip hemiarthroplasty). This is a straightforward and well-established procedure performed by orthopaedic surgeons that allows patients to immediately bear weight and regain significant mobility. Unfortunately, this essential surgery is unavailable to many patients worldwide poor due to the high cost of the implant. Safe, effective, and affordable orthopaedic trauma surgery and rehabilitation can preserve healthy longevity and prevent financial catastrophe. Moreover, multiple studies have shown that interdisciplinary management of elderly patients with musculoskeletal injuries with holistic, geriatric-minded care decreases comorbid burden and mortality, improves early mobilization, and preserves function. Novel interdisciplinary co-management approaches to perioperative care of elderly patients with hip fractures could shorten hospital length of stay, improve overall outcome, and thus decrease hospital and healthcare associated costs. China has in recent decades emerged as an international leader in the development of affordable and high-quality orthopaedic implants. Although many of these devices have been tested by their manufacturers and received regulatory approvals, their long-term clinical safety and efficacy have not been rigorously studied. Chinese hospitals also face a large burden of elderly patients with fragility fractures given the large and aging population. The availability of high-quality care for rural and peri-urban populations is unclear, especially those without financial resources to visit private, urban hospitals. We aim to evaluate the cost-effectiveness of a novel approach to hip fracture care developed in China, using Chinese-manufactured hip hemiarthroplasty implants and China-specific novel protocol for interdisciplinary co-management of geriatric hip fracture patients. This holistic approach, specifically developed to benefit poorer geriatric patient populations in rural/peri urban areas could be a future model for cost-effective and affordable hip fracture care for patients around the world.