Tohidi Mina, Mann Stephen M, McIsaac Michael A, Groome Patti A
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Department of Surgery, Queen's University, Kingston, Ontario, Canada.
J Bone Joint Surg Am. 2023 Apr 19;105(8):591-599. doi: 10.2106/JBJS.22.01193. Epub 2023 Feb 9.
The optimal treatment of older patients with a displaced femoral neck fracture remains a controversial topic. This study aimed to compare clinical outcomes across a matched group of patients with a femoral neck fracture treated with either hemiarthroplasty or total hip arthroplasty (THA).
Routinely collected health-care databases were linked to create a population-based cohort of 49,597 patients ≥60 years old from Ontario, Canada, who underwent hemiarthroplasty or THA for a femoral neck fracture between 2002 and 2017. A propensity-score-matched cohort was created using relevant and available predictors of treatment assignment and outcomes of interest. Clinical outcomes consisting of hip dislocation, revision surgery, hospital readmission, and death were compared in the matched cohort using survival analysis.
Over 99% of THA patients (4,612) were adequately matched 1:1 to hemiarthroplasty patients (total matched cohort = 9,224). Patients treated with THA were at higher risk for hip dislocation at 30 days and 1 and 2 years postoperatively (2-year risk, 1.8% for THA versus 0.8% for hemiarthroplasty; p < 0.001). There was no difference in the short-term (30-day) or long-term (up to 10-year) risk of revision surgery between treatment groups. There was no significant difference in the risk of 30-day hospital readmission between groups. The risk of death at 1 year and 2 years postoperatively was lower for patients treated with THA.
For patients with a hip fracture, shared decision-making should involve discussion of the potential higher risk of short-term hip dislocation after THA compared with hemiarthroplasty. The risk of revision surgery was similar between treatment groups at up to 10 years of follow-up.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
老年移位型股骨颈骨折的最佳治疗方法仍是一个有争议的话题。本研究旨在比较一组匹配的接受半髋关节置换术或全髋关节置换术（THA）治疗的股骨颈骨折患者的临床结局。
将常规收集的医疗保健数据库相链接，以创建一个基于人群的队列，该队列由来自加拿大安大略省的49597名60岁及以上的患者组成，这些患者在2002年至2017年间因股骨颈骨折接受了半髋关节置换术或THA。使用治疗分配和感兴趣结局的相关可用预测因素创建倾向评分匹配队列。在匹配队列中使用生存分析比较包括髋关节脱位、翻修手术、医院再入院和死亡在内的临床结局。
超过99%的THA患者（4612例）与半髋关节置换术患者进行了充分的1:1匹配（总匹配队列=9224例）。接受THA治疗的患者在术后30天、1年和2年发生髋关节脱位的风险较高（2年风险，THA为1.8%，半髋关节置换术为0.8%；p<0.001）。治疗组之间短期（30天）或长期（长达10年）翻修手术风险没有差异。两组之间30天医院再入院风险没有显著差异。接受THA治疗的患者术后1年和2年的死亡风险较低。
对于髋部骨折患者，共同决策应包括讨论与半髋关节置换术相比，THA后短期髋关节脱位的潜在更高风险。在长达10年的随访中，治疗组之间的翻修手术风险相似。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
