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8%
Synopsis: 220 patients with isolated pertrochanteric femoral fractures were randomized to receive surgical intervention with a short or long cephalomedullary nail.Primary outcomes of interest included the Short Form 36 (SF-36) questionnaire and the Harris Hip Score.Secondary outcomes of interest included implant failure, peri-implant failure, mortality, operative time, estimated blood loss and the incidence of re-operation.Outcomes were assessed up to 12 months post-operation.Results revealed significantly favourable 3 month Harris Hip scores, lower operative time and lower estimated blood loss in the short nail group compared to the long nail group. No significant differences... Read More »
Level 2 RCT
4%
Synopsis: Femoral neck fractures, a type of hip fracture, are a common and disabling injury, particularly given an ageing population in many countries.Throughout the past half-century, multiple different treatments have evolved for the treatment of these fractures, and these include sliding hip screws, cannulated screws, hemiarthroplasty (HA), and total hip arthroplasty (THA).Given that femoral neck fractures have the potential to compromise blood flow to the femoral head, arthroplasty options have gained prominence in recent years.However, it remains unclear which of the two options (THA or HA) is optimal in this population.Thus, in this definitive, landmark randomized controlled trial, which is by far the largest of its kind to date, the investigators randomized 1495 patients 50 years of age older with a displaced femoral neck fracture to undergo HA or THA.The trial was conducted across 80 centres in 10 different countries.Primary outcome was a secondary hip procedure within 24 months.Secondary endpoints included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health.There was no significant difference between the two groups in terms of revision rate, mortality, serious adverse events, revision procedures, EQ-5D, timed up and go test, or Short-Form 12 scores.There was a trend toward higher dislocation rates in THA, though this was not statistically significant.There was a significant difference in favour of THA on the WOMAC total and sub-scores, though this difference fell below the minimal clinically important threshold.Overall, in the absence of a convincing indication for THA, HA is a comparable treatment for femoral neck fracture which does not result in a significant difference in revision rate.There may be a slightly higher rate of serious adverse events with THA, and slightly better function with THA, though these differences may not reach clinical significance. Read More »
Level 1 RCT
3%
Synopsis: 9 studies were included in this meta-analysis (5 RCTs and 4 quasi RCTs) to compare the outcomes of total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fracture in elderly patients.A total of 1208 patients were identified from the 9 studies, with follow-up ranging from 12-156 months.Results of the analysis indicated that the use of total hip arthroplasty treatment had reduced pain and reoperation rates, but increased in rate of dislocation when compared to hemiarthroplasty. The two treatments... Read More »
Level 1 Meta Analysis
3%
Synopsis: 1108 patients with a hip fracture were randomized to fixation through either a sliding hip screw or cancellous screws.The outcomes of interest included reoperation rate and patient-reported outcome measures (PROMs) over a 24-month follow-up.The overall rate of reoperation for any reason did not significantly differ between groups, 20% in the sliding hip screw group and 22% for patients in the cancellous screws group. Rates of implant... Read More »
Level 1 RCT
3%
Synopsis: Forty-nine thousand, five hundred and ninety-seven patients aged 60 years or older from Ontario who underwent either total hip arthroplasty or hemi-arthroplasty for the treatment of displaced femoral neck fractures were included in this retrospective study examining clinical outcomes and associated factors with each procedure.A matched cohort of 9,238 patients was used to compare clinical outcomes.Outcomes of interest included the risk of hip dislocation, revision surgery, and death.Results of the study found a higher risk of 1-year revision surgery and dislocation in the total hip arthroplasty group compared to the hemi-arthroplasty group. The risk of... Read More »
Conference Report
1%
Synopsis: 161 patients undergoing shoulder arthroplasty for primary shoulder osteoarthritis were randomized to either cemented fixation (control) of the humeral component or uncemented fixation in order to determine the potential of uncemented fixation to decrease operative time, while still providing stable fixation. Assessment, at follow-up to 24 months, demonstrated that the cemented arthroplasty group had superior clinical outcomes in the form of strength and function. Read More »
Author verified Level 2 RCT
1%
Synopsis: 65 patients who underwent total knee arthroplasty were randomly assigned to either receive telerehabilitation or traditional outpatient physical therapy.This study was conducted to test the non-inferiority of telerehabilitation treatment.The results from this study indicated that the telerehabilitation treatment was equivalent to the traditional outpatient physical therapy, though it should be noted that the telerehabilitation was not conducted in a home setting, but in an environment which was simulated at a hospital. This may have... Read More »
Author verified Level 2 RCT
1%
Synopsis: 196 hips undergoing primary total hip arthroplasty were randomized to two different surgical techniques to examine rates of dislocation and complication postoperatively.Patients were randomized to a posterior approach with soft tissue repair or a lateral approach to THA. Results from a... Read More »
Level 2 RCT
1%
Synopsis: 101 patients with hip osteoarthritis were randomized to receive one of three intra-articular treatments guided by ultrasound.The patients received either an intervention of hyaluronic acid (HA), a corticosteroid intervention, or a treatment of isotonic saline.The primary outcome was "pain on walking" as measured by VAS.Results indicated a small clinical improvement with the hyaluronic acid treatment.However, it cannot be recommended as standard therapy due to its lack of significance over the 3-month study period. Significant improvements were... Read More »
Level 1 RCT
1%
Synopsis: This meta-analysis identified 8 randomized trials, comparing the use of total hip arthroplasty (THA) or hemiarthroplasty (HA) for the treatment of displaced femoral neck fractures in the elderly.The primary outcome assessed was the rate of re-operation, with secondary outcomes being mortality and dislocation rate, pain, function and quality of life.Results from the analysis indicated that THA provided better functional and pain outcomes using the Harris Hip score compared to HA.However, THA was associated with a greater risk of dislocation. Further large scale... Read More »
Author verified Level 1 Meta Analysis