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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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.
De que é que me devo lembrar mais?
The data suggest that the minimally invasive direct anterior approach results in better mobilization outcomes and less pain than the conservative Watson-Jones-Approach.
Como é que isto afectará o tratamento dos meus doentes?
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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