Can the Nottingham Hip Fracture Score Predict Total Hip Replacement Versus Hemiarthroplasty Candidates?

BACKGROUND: The choice between total hip replacement (THR) and hemiarthroplasty in displaced intracapsular hip fractures remains debated. Procedure selection can be difficult given the current evidence. Using the Nottingham Hip Fracture Score (NHFS), we aimed to introduce objectivity into decision-making. METHODS: This is a retrospective single-centre review (2019-2023) of 1210 patients undergoing THR (n=228) or hemiarthroplasty (n=982). NHFS was calculated for all patients in this time period. Outcomes included one‑year mortality and discharge destination, with subgroup analysis of NHFS 4-6 and patients aged >80 with NHFS 4-6. Statistical analysis was completed using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, New York, United States).  Results: Hemiarthroplasty patients were older (82.2 vs. 74.6 years) and had higher mean NHFS (6.0 vs. 3.5) and higher one‑year mortality (36.2% vs. 3.5%). In the overall cohort, THR patients were more likely to be discharged home (65% vs. 39%), while hemiarthroplasty patients were more often discharged to institutional care. In the NHFS 4-6 subgroup, THR patients had lower mortality (3.4% vs. 29.6%; p<0.05) and more frequent home discharge (77.7% vs. 43.9%). In patients over 80 with NHFS 4-6, THR was associated with lower one-year mortality (4.2% vs. 13.8%) and a higher likelihood of independent living at home (75% vs. 60.9%) compared with hemiarthroplasty, although differences did not reach statistical significance. CONCLUSION: Hemiarthroplasty patients are older and have higher mortality. Within NHFS 4-6 and in some circumstances, THR was associated with lower mortality and more favourable discharge outcomes. NHFS may complement the National Institute for Health and Care Excellence (NICE) guidance in identifying candidates most likely to benefit from THR vs. hip hemiarthroplasty.