Overall outcome better with THA vs hemiarthroplasty in elderly with hip fracture .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(15):22 PLoS One. 2014 May 22;9(5):e98071. doi: 10.1371/journal.pone.0098071.8 randomized controlled trials (n=983) were included in this meta-analysis comparing outcomes between total hip arthroplasty and hemiarthroplasty in elderly patients. Results indicated significantly higher Harris Hip scores and a significantly lower risk of revision in the total hip arthroplasty group when compared to hemiarthroplasty. There was, however, a trend towards a higher rate of dislocation for total hip arthroplasty, although not statistically significant. The most common complication requiring revision surgery was acetabular erosion. As a whole, total hip arthroplasty appeared to be favoured over hemiarthroplasty in this population.
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نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
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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
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Fractures of the femoral head are becoming increasingly prevalent with the aging population. Treatment options include internal fixation, hemiarthroplasty, and total hip arthroplasty. The latter two options are preferred over internal fixation, due to the associated risks of nonunion, avascular necrosis, and mechanical failure with fixation. However, the optimal method between the two arthroplasty techniques for elderly individuals remains controversial, emphasizing a need for this meta-analysis.
ما هو سؤال البحث الرئيسي؟
How do hemiarthroplasty and total hip arthroplasty compare in elderly patients?
- Harris hip scores (HHS) were reported in 5 studies. Pooled results significantly favoured total hip arthroplasty over hemiarthroplasty at 1 year (SMD: -7.11 [95% CI -10.70 to -3.53]; p<0.05) and 2 years postoperatively (SMD:-6.91 [95% CI -12.98 to -0.85]; p<0.05).
- Dislocation rate was measured in 6 studies; 5 studies were pooled (n=691). Results indicated a non-significant trend towards a higher rate for total hip arthroplasty (33/390) compared to hemiarthroplasty (14/421), (RR: 0.46 [95% CI 0.21-1.02]; P = 0.06; I-squared = 14%) with low heterogeneity.
- Revision rates were reported in 5 studies, and pooling demonstrated a higher revision rate for hemiarthroplasty (32/352) compared to total hip arthroplasty (11/321) (RR: 2.58 [95% CI 1.04-6.40]; P=0.04; I-squared = 19%), with low heterogeneity.
- Complications resulting in revision surgery for hemiarthroplasty were most commonly acetabular erosion, followed by periprosthetic fracture, acetabulum osteoarthritis, and deep infection. For total hip arthroplasty, the most common was infection, followed by femoral stem subsidence, acetabulum osteoarthritis and dislocation.
- Heterogeneity in reporting of surgical time, blood loss and transfusion did not allow for pooling.
ما الذي يجب أن أتذكره أكثر؟
Total hip arthroplasty was associated with significantly higher Harris Hip scores and a lower risk for revision, while hemiarthroplasty resulted in a lower dislocation rate. The most common complication for total hip arthroplasty was infection, whereas acetabular erosion was highest in hemiarthroplasty.
كيف سيؤثر ذلك على رعاية مرضاي؟
As a whole, the results from this analysis suggest total hip arthroplasty may hold benefits over hemiarthroplasty in elderly patients with a femoral head fracture. Patients treated with total hip arthroplasty appeared to enjoy better hip outcomes and lower revision rates. Trials with longer follow-up and assessment of health-related quality of life outcomes are recommended to add to this body of literature. Addtionally, further research should consider possible methods of reducing dislocation rates for those undergoing total hip arthroplasty.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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