Remote ischaemic conditioning following acute hip fracture (RIC-FRACTURE)

Introduction

Hip fracture is the commonest fracture in adults over 60 years, with high morbidity and mortality. Remote Ischaemic Conditioning (RIC) is a non-invasive intervention consisting of brief, repeated cycles of limb ischaemia and reperfusion for periods that avoid physical injury to the limbs, but induce neurohormonal, systemic or vascular changes in the body. Studies have demonstrated that RIC may have anti-inflammatory and cardiovascular protective effects following orthopaedic surgery and could represent a novel therapeutic strategy to improve outcomes.

Method

This was a single-arm proof-of-concept study of RIC following acute hip fracture. Adults with hip fracture following a fall from standing height or less (diagnosed within the preceding 7 days on X-ray/CT scan) at the Northern General Hospital, Sheffield were identified. RIC was delivered daily for up to two weeks or until discharge (maximum 10 sessions) by trained researchers. Primary outcomes were safety, feasibility, acceptability and compliance. Secondary outcomes included exploratory clinical outcomes.

Results

23 participants were recruited over 7 months. Ages ranged from 65 to 90 years (median = 81, IQR 77-86) and 70% were female. Median number of co-morbidities was 5 (IQR 3-6) and medications was 6 (IQR 3-9). 52% had an intracapsular and 48% extracapsular fracture. 39% underwent dynamic hip screw surgery, 35% hemiarthroplasty, 13% total hip replacement and 13% intramedullary nail. Safety, feasibility and acceptability were demonstrated. However, compliance was not met as only 64% of treatments were delivered as per protocol. Two participants died (9%) and two (9%) were readmitted to hospital during 3-month follow-up. Function (Barthel Index) improved from admission to 3-month follow-up and pain score (VAS) improved during admission.

Conclusion

It is possible to perform RIC following acute hip fracture and a randomised controlled trial is practicable and justified. Future work will explore mechanistic outcomes through blood marker analysis.