Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2020 Nov;35(11):3188-3194. doi: 10.1016/j.arth.2020.06.015. Epub 2020 Jun 15.
Geriatric femoral neck fracture is a common injury for which hemiarthroplasty (HA) or total hip arthroplasty (THA) may be considered in select patients. As prior database studies comparing these have not used propensity matching, which is a robust statistical method of controlling for potentially confounding variables, unmatched and matched methodologies are contrasted in the present study.
Patients aged ≥70 years who underwent HA or THA for hip fractures were identified from the 2012-2015 National Surgical Quality Improvement database. Propensity score 1:1 matching was performed. Differences in rates of 30-day postoperative adverse outcomes were compared using multivariate logistic regression for unmatched and matched cohorts.
In total, 15,558 patients (14,403 HA and 1155 THA) were evaluated. Although multivariate outcomes for the unmatched populations were different for blood transfusion, mortality, minor adverse events, major adverse events, and reoperation, multivariate outcomes for matched populations only differed for blood transfusion (odds ratio 0.6 for HA vs THA, P < .001). Of note, although readmissions were similar for the two groups, patients undergoing THA had a 5.4% greater rate of perioperative readmission due to dislocation.
Geriatric patients undergoing HA and THA for hip fracture were compared with and without propensity matching. Once matching was performed, the only differences in outcomes between the two groups were a lower transfusion rate among the HA group and a greater readmission rate due to dislocation among the THA group. This suggests that either procedure can be safely considered if found to be advantageous from a longer-term outcome perspective.
Level III, retrospective comparative study.
老年股骨颈骨折是一种常见的损伤，对于某些患者，可以考虑行人工股骨头置换术（HA）或全髋关节置换术（THA）。由于之前的数据库研究没有使用倾向匹配，这是一种控制潜在混杂变量的强大统计方法，因此本研究对比了未匹配和匹配的方法。
从 2012 年至 2015 年国家手术质量改进数据库中确定了年龄≥70 岁因髋部骨折行 HA 或 THA 的患者。采用倾向评分 1:1 匹配。使用多变量逻辑回归比较未匹配和匹配队列中 30 天术后不良结局的发生率。
共评估了 15558 例患者（14403 例行 HA，1155 例行 THA）。尽管未匹配人群的多变量结果在输血、死亡率、轻微不良事件、重大不良事件和再次手术方面有所不同，但匹配人群的多变量结果仅在输血方面有所不同（HA 与 THA 的比值比为 0.6，P<0.001）。值得注意的是，尽管两组的再入院率相似，但行 THA 的患者因脱位导致围手术期再入院的发生率高 5.4%。
比较了老年股骨颈骨折患者行 HA 和 THA 的情况，有无倾向匹配。一旦进行匹配，两组之间的结果差异仅在于 HA 组的输血率较低，THA 组因脱位导致的再入院率较高。这表明如果从长期结果的角度来看，两种手术都可以安全考虑。
III 级，回顾性比较研究。
