ARTHROPLASTY
Immediate weight bearing after uncemented total hip arthroplasty with an anteverted stem: A prospective randomized comparison using radiostereometry
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):95 Acta Orthop. 2007 Dec;78(6):730-843 patients undergoing uncemented total hip arthroplasty (THA) with hydroxyapatite coating and anteverted stem were randomized to undergo one of two procedures postoperatively. The first group participated in early full weight bearing while the second group participated in early partial weight bearing. The primary outcomes were migration of the stem and cup, as well as the penetration of the femoral head. Results at the 3-month follow-up indicated there were no adverse effects on early full weight bearing after THA.
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Early weight bearing is often recommended and administered following total hip arthroplasty (THA), but there is still a lack of evidence to support this procedure. Some recent studies have examined clinical results in early weight bearing but there have yet to be any studies where analysis is performed using radiostereometry. This study examines the outcomes of early full and partial weight bearing after THA using radiostereometry to assess migration of the stem and cup as well as penetration of the femoral head.
主な研究課題は何ですか？
What are the outcomes of early full and partial weight bearing after uncemented total hip arthroplasty on migration of the stem and cup, as well as the penetration of the femoral head in patients with hip osteoarthritis at 3 months?
重要な知見は？
- The partial weight bearing group (control) had a mean proximal (+)/ distal (-) migration of the stem of -0.14 mm (-1.93-0.11) at 3 months compared to the full weight bearing group (intervention) which had a migration of -0.31 mm (-4.30-0.16). (p=0.6)
- The mean migration at the 1-year follow-up was -0.17 mm (-2.18-0.21) for the partial weight bearing group and -0.28 mm (-4.31-0.11) for the full weight bearing group. (p=0.9)
- No significant differences were seen in stem rotations between the two groups. (p>0.2)
- Both groups had similar cup translations, rotations, and femoral head penetration. (p>0.1)
最も覚えておくべきことは？
Full weight bearing immediately after uncemented total hip arthroplasty (THA) is justified under the conditions of this study. No adverse effects were seen in patients undergoing the early full weight bearing procedure initially and up to the 1-year follow-up after THA.
それが私の患者ケアにどのように影響するか？
Full weight bearing after THA is a justifiable option for postoperative management in patients based on the findings of this study. However, further trials are required to assess if early weight bearing provides clinically significant improvements in functional outcomes for patients undergoing THA.
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