Fracture Department, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
J Orthop Trauma. 2022 Jan 1;36(1):17-22. doi: 10.1097/BOT.0000000000002143.
To examine outcome for patients with hip fracture treated by a hemiarthroplasty (HA) but who actually met the United Kingdom, National Institute for Health and Care Excellence (NICE) criteria for receiving a total hip arthroplasty (THA).
Match cohort study.
Level 1, Academic Trauma Centre (UK Major Trauma Centre).
PATIENTS/PARTICIPANTS: Three hundred ninety-eight patients underwent either a HA or THA for a nonpathological displaced intracapsular fractured neck of the femur [OTA/AO 31 B3 (garden 3-4)], having met the NICE criteria for THA.
HA versus THA. Two analyses were performed, the first comparing the outcome in a cohort of patients who either received a THA or HA but who all had met the NICE criteria to receive a THA (n = 398). The second analysis assessed the outcome of THA versus HA, in a matched cohort of patients who all met the NICE criteria for a THA (n = 44 matched pairs). All patients in the matched cohort were able to walk independently outdoors (WIOs) before injury.
Mobility and functional outcome, 1 year after surgery.
Of the 398 patients who met the criteria for THA, only 78 (19.6%) patients actually received a THA. Within the matched cohort, significantly more THA patients (92.9%, 39/42) maintained the ability to WIOs at 1-year compared with patients with HA (56.4%, 22/39; P = 0.001). There was no difference in mortality, reoperation, or complication rates for our matched population at 1 year.
Patients who meet the NICE criteria for THA and are able to WIOs preinjury are more likely to have a higher level of independent mobility and a better functional outcome at 1-year if they receive a THA, as opposed to receiving a HA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
研究接受半髋关节置换术（HA）但实际上符合英国国家卫生与临床优化研究所（NICE）接受全髋关节置换术（THA）标准的髋部骨折患者的治疗结果。
匹配队列研究。
1 级，学术创伤中心（英国主要创伤中心）。
患者/参与者：398 例因非病理性移位性囊内股骨颈骨折（OTA/AO 31 B3（花园 3-4））接受 HA 或 THA 治疗的患者，均符合 NICE 推荐 THA 的标准。
HA 与 THA。进行了两项分析，第一项比较了一组接受 THA 或 HA 治疗但均符合 NICE 推荐 THA 标准的患者的治疗结果（n = 398）。第二项分析评估了符合 NICE 推荐 THA 标准的匹配队列中 THA 与 HA 的治疗结果（n = 44 对匹配）。所有匹配队列中的患者在受伤前均能独立在户外行走（WIOs）。
手术后 1 年的活动能力和功能结局。
在符合 THA 标准的 398 例患者中，仅有 78 例（19.6%）患者实际接受了 THA。在匹配队列中，与 HA 患者相比，接受 THA 的患者在 1 年时能够保持 WIOs 的能力显著更高（92.9%，39/42），而 HA 患者为 56.4%（22/39；P = 0.001）。在 1 年时，我们的匹配人群在死亡率、再次手术率或并发症发生率方面没有差异。
符合 NICE 推荐 THA 标准且术前能够 WIOs 的患者，如果接受 THA，而不是 HA，则更有可能在 1 年时获得更高水平的独立活动能力和更好的功能结局。
治疗性 3 级。有关证据水平的完整说明，请参见作者说明。
