Similar Function and Adverse Events between THA and Hemiarthroplasty for Femoral Neck Fracture .
Questo studio è stato identificato come potenzialmente ad alto impatto.
La metrica High Impact di OE, guidata dall'AI, stima l'influenza che un articolo potrebbe avere integrando i segnali della rivista in cui è stato pubblicato e il contenuto scientifico dell'articolo stesso.
Sviluppato utilizzando un'elaborazione del linguaggio naturale all'avanguardia, il modello High Impact di OE prevede in modo più accurato la futura performance citazionale di uno studio rispetto al solo fattore di impatto della rivista.
Ciò consente di riconoscere prima le ricerche clinicamente significative e aiuta i lettori a concentrarsi sugli articoli che hanno maggiori probabilità di influenzare la pratica futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(3):38 J Arthroplasty. 2019;(34)8:1837-1843.10.1016/j.arth.2019.03.070A meta-analysis of 17 studies (13 different trials), including randomized and prospective controlled trial was performed, with a total of 1364 patients. The outcomes of interest included mortality at 1 month, 1 year, and overall, infection, dislocation, revision, function (Harris Hip Score (HHS)) and Health-Related Quality of Life (HRQoL, based on Short-Form (SF)-36). Subgroup analyses were performed looking at unipolar vs. bipolar HA, mean age < or > than 80 years, and follow-up < or > 4 years. The included studies assigned patients to total hip arthroplasty (THA) versus hemairthroplasty (HA) for displaced femoral neck fractures (Garden III and Garden IV). Follow-up ranged from1 to 13 years. There was no difference in overall mortality, 30-day mortality, or 1-year mortality. There was also no difference between the two groups in in terms of infection, revision rate, function, or HRQoL. There was a significantly lower rate of dislocation in the HA group compared to THA (RR 0.37, p < 0.0001). The only finding that changed with subgroup analysis was that dislocation rate was only different in the first four years of follow-up, but not in studies with longer follow-up.
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Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
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How would you rate the scientific quality of this evidence?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Qual era la domanda di ricerca principale?
In patients with displaced femoral neck fractures, does hemiarthroplasty, compared to total hip arthroplasty, result in any difference in functional outcomes, mortality, or other adverse events?
- There was no significant difference between total hip arthroplasty and hemiarthroplasty in terms of mortality at 1 month (THA: 5.2% vs. HA: 3.7%, p = 0.42), 1 year (THA: 13.3% vs. HA: 14.4% , p = 0.63), or final follow-up.
- There was no significant difference between THA and HA in terms of infection (THA: 2.5% vs. HA: 2.6%, p = 0.89) or revision (THA: 5.7% vs. HA: 8.8%, p = 0.05)
- There were no significant differences in terms of Harris Hip Score or Short-Form 36 scores
- There was a significant difference between the two groups in terms of dislocation rate (THA: 8.1% vs. HA: 2.67%, p = 0.0001)
- Subgroup analysis revealed no changes to the above findings for mean age > or < 80 years of age or bipolar vs unipolar HA
- Subgroup analysis revealed no significant difference in dislocation rate in studies with follow up > than 4 years
Che cosa devo ricordare di più?
Overall, in terms of mortality, infection, revision, function, and health-related quality of life, total hip arthroplasty (THA) is similar to hemiarthroplasty in patients with displaced femoral neck fracture (Garden III and Garden IV). There is a significantly higher dislocation rate in the short to medium-term with THA, though this effect washes out beyond four years of follow-up.
Come influenzerà l'assistenza ai miei pazienti?
Based on this study, there is no convincing reason to opt for total hip arthroplasty, which involves a longer and more extensive surgical procedure, for most patients with displaced femoral neck fracture. This remains true regardless of patient age. If the decision is made to opt for total hip arthroplasty, surgeons may wish to consider strategies to reduce the likelihood of dislocation such as the use of dual mobility acetabular components.
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Il contenuto di questa pagina è solo a scopo informativo e non intende sostituire la consulenza, la diagnosi o il trattamento medico professionale. Se ha bisogno di cure mediche, si rivolga sempre al suo medico o al pronto soccorso più vicino. Le opinioni, le convinzioni e i punti di vista espressi dalle persone sui contenuti presenti in questa pagina non riflettono le opinioni, le convinzioni e i punti di vista di OrthoEvidence.
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