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Total hip arthroplasty versus hemiarthroplasty for independently mobile older adults with intracapsular hip fractures

Research output: Contribution to journalArticle

Original languageEnglish
Article number226
Number of pages11
JournalBMC Musculoskeletal Disorders
Volume20
Issue number1
DOIs
DateAccepted/In press - 25 Apr 2019
DatePublished (current) - 17 May 2019

Abstract

Background:Displaced intracapsular hip fractures are typically treated with hemiarthroplasty (HA) or total hip arthroplasty (THA). A number of professional bodies recommend considering THA for patients that were independently mobile and cognitively intact before injury. The aim of this study was to compare the outcomes between HA and THA for independently mobile older adults with hip fractures.
Methods:A systematic review and meta-analysis of RCTs was undertaken alongside analysis of a propensity score matched national cohort of older adults (aged >60) with hip fractures. Participants were identified for the propensity score matched cohort from the National Hip Fracture Database (NHFD), which was linked to Hospital Episode Statistics (HES) and civil death registration data. The primary outcomes were 12-month dislocation, revision, and mortality. The secondary outcomes were length of stay, discharge home, unplanned re-admission, functional outcomes, and healthrelated quality of life.
Results:Five RCTs reported higher THA dislocation but this was not statistically significant (THA risk ratio [RR] 2.77, 95% CI 0.81 to 9.48). However, THA dislocation was significantly higher in the national observational dataset (sub-distribution hazard ratio [SHR] 1.73, 95% CI 1.24 to 2.41). Metaanalysis of data from four RCTs did not identify a significant difference in terms of revision (RR 1.52, 95% CI 0.56 to 4.14). However, THA revision was significantly lower in the national dataset (SHR 0.66, 95% CI 0.48 to 0.90). Meta-analysis of data from 5 RCTs suggested higher mortality amongst patients undergoing HA (RR 0.63, 95% CI 0.38 to 1.04), which was also observed within the national registry dataset (hazard ratio 0.45, 95% CI 0.37 to 0.54).
Conclusions:National clinical registries can provide important context when interpreting RCT data, which may alone be inadequate for comparing the safety profile of surgical interventions. These data suggest that THA is at significantly higher risk of dislocation but lower risk of revision within 12 months. The finding from both RCT and clinical registry data that THA is associated with lower 12-month mortality amongst the fittest patients with hip fractures requires urgent further study to determine whether or not this can be replicated in other balanced populations.

    Research areas

  • Hemiarthroplasty, Hip fractures, Total hip replacement

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Springer Nature at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2590-4 . Please refer to any applicable terms of use of the publisher.

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    Licence: CC BY

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