Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Acta Orthop. 2010 Feb;81(1):122-5. doi: 10.3109/17453671003587093.
The impact of large, randomized trials in orthopedic surgery on surgeons' preferences for a particular surgical approach remains unclear. We surveyed surgeons to assess whether they would change practice based upon results of a large, multicenter randomized controlled hip fracture trial.
We conducted a cross-sectional survey among International Hip Fracture Research Collaborative (IHFRC) surgeons and surgeons who were members of Arbeitsgemeinschaft fuer Osteosynthesefragen - Association for the Study of Internal Fixation (AO/ASIF) to determine the likelihood that they would change practice based on findings of a proposed large, multicenter randomized controlled trial (the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty (HEALTH) study). We asked surgeons their current preferences for the management of displaced femoral neck fractures and whether a trial that definitively revealed a substantial improvement in function and quality of life with no difference in risk of revision surgery was important and would cause them to change practice.
Of 883 surgeons surveyed, 210 responded from IHFRC and 586 from AO/ASIF (a response rate of 90%). Most surgeons (61%) preferred hemiarthroplasty (HA) for treating displaced femoral neck fractures. 72% of responding surgeons believed that a substantial improvement in patient function with total hip arthroplasty (THA) and no adverse effects on revision surgery would be an important finding. Moreover, of 483 surgeons who preferred hemiarthroplasty, 62% would change their practice based upon the findings of the trial.
Large clinical trials in orthopedics are worthwhile endeavors, as they have the potential to change practice among surgeons. Surgeons seem willing to adopt alternative surgical approaches if the evidence is compelling and sound.
在骨科手术中，大型随机试验对外科医生对特定手术方法的偏好的影响尚不清楚。我们对外科医生进行了调查，以评估他们是否会根据一项大型多中心随机对照髋部骨折试验的结果改变治疗方法。
我们对国际髋部骨折研究协作组（IHFRC）的外科医生和 Arbeitsgemeinschaft fuer Osteosynthesefragen- Association for the Study of Internal Fixation（AO/ASIF）的成员进行了横断面调查，以确定他们根据拟议的大型多中心随机对照试验（髋部骨折评估与全髋关节置换与半髋关节置换的替代方案（HEALTH）研究）的结果改变治疗方法的可能性。我们询问了外科医生他们目前对移位股骨颈骨折的管理偏好，以及一项明确显示功能和生活质量有实质性改善且手术翻修风险无差异的试验是否重要，并会导致他们改变治疗方法。
在接受调查的 883 名外科医生中，有 210 名来自 IHFRC，586 名来自 AO/ASIF（应答率为 90%）。大多数外科医生（61%）首选半髋关节置换术（HA）治疗移位股骨颈骨折。72%的应答外科医生认为，全髋关节置换术（THA）患者功能有实质性改善且对手术翻修无不良影响将是一个重要发现。此外，在 483 名首选半髋关节置换术的外科医生中，有 62%的人会根据试验结果改变他们的治疗方法。
骨科的大型临床试验是值得进行的努力，因为它们有可能改变外科医生的治疗方法。如果证据确凿且合理，外科医生似乎愿意采用替代手术方法。
