Femoral neck fracture: Minimally invasive hemiarthroplasty results in early mobilization .
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original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):60 BMC Musculoskelet Disord. 2012 Aug 8;13:141. doi: 10.1186/1471-2474-13-141.60 patients with fractured femur necks undergoing bipolar hemiarthroplasty were randomized to receive the conventional Watson-Jones approach or the minimally invasive Direct Anterior Approach (DAA). The results of the study indicate that the minimally invasive direct anterior approach allows for improved early mobilization status and reduced pain when compared to the conventional Watson-Jones-Approach.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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Randomization
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Outcome Measurements
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Inclusion / Exclusion
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Therapy Description
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Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
As the global population ages, there is an increasing incidence of osteoporosis related hip fractures and subsequent hip fracture complications. Early mobilization after corrective hip arthroplasty has been shown to combat the morbidity and mortality associated with hip fractures. Previous studies examining the effects of conventional and minimally invasive hip arthroplasty on mobilization resulted in conflicting results regarding hip function, pain, and mobilization. This study aimed to determine whether femoral neck fractures treated by conventional bipolar hemiarthroplasty or minimally invasive bipolar hemiarthroplasty result in differences in mobilization outcomes.
¿Cuál era la pregunta principal de la investigación?
Do femoral neck fractures treated by conventional bipolar hemiarthroplasty differ from those treated by minimally invasive hemiarthroplasty with respect to mobilization outcomes when compared 40 days after surgical treatment?
- By the 5th postoperative day, the DAA group achieved a Barthel score of 20, whereas the Watson-Jones group achieved a Barthel score of 10 (p=0.009). The difference in mobilization between the two treatment groups remained significant at the final follow-up on the 40th postoperative day (p=0.013).
- There was no significant difference in postoperative pain until the 16th postoperative day in which the DAA group experienced significantly less pain than the Watson-Jones group (p=0.035). The patients in the DAA group also experienced significantly less pain than the patients in the Watson-Jones group on the 40th postoperative day (p=0.0004).
- There were no significant differences in packed red cell requirements between the patients in the DAA group and the patients in the Watson-Jones group at any point in time during the follow-up period.
- The femoral offset and leg length was not clinically different between the DAA group and the Watson-Jones group (p=0.19 and p=0.23, respectively). Normal prosthesis alignment was found in 77% of patients in the DAA group and 71.5% of patients in the Watson-Jones group.
- From the DAA group, 1 patient developed deep vein thrombosis, and 1 patient developed a wound edge necrosis at the proximal wound pole. From the Watson-Jones group, 2 patients developed deep vein thrombosis, 1 patient developed an infected haematoma, and 1 patient required 12 units of packed red cells for a unknown reason.
¿Qué es lo que más debo recordar?
The data suggest that the minimally invasive direct anterior approach results in better mobilization outcomes and less pain than the conservative Watson-Jones-Approach.
¿Cómo afectará esto al cuidado de mis pacientes?
The study suggests that bipolar hemiarthroplasty via the minimally invasive direct anterior approach results in better early mobilization outcomes than bipolar hemiarthroplasty via the conservative Watson-Jones-Approach. Further research using larger sample sizes and longer follow-up periods are required to determine if improved mobilization results in fewer complications.
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