Ahmad Zafar, Axelrod Daniel, Comeau-Gauthier Marianne, Bzovsky Sofia, Poolman Rudolf W, Frihagen Frede, Bhandari Mohit, Swiontkowski Marc, Sprague Sheila, Schemitsch Emil
Department of Surgery, Western University, London, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
OTA Int. 2025 May 29;8(2):e404. doi: 10.1097/OI9.0000000000000404. eCollection 2025 Jun.
To evaluate functional outcomes amongst femoral neck fracture trial participants who did not undergo reoperation.
Secondary analysis of 2 randomized controlled trials.
Ninety hospitals in 5 continents.
Patients aged 50 years or older with a femoral neck fracture.
Arthroplasty, including total hip arthroplasty and hemiarthroplasty, or internal fixation, including sliding hip screw or multiple cancellous screws.
The Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-item Short Form Health Survey (SF-12) physical component summary (PCS).
Data from 716 arthroplasty patients and 549 internal fixation patients were included in our propensity score weighting model. Internal fixation patients had higher WOMAC stiffness scores (leading to poorer function) at 24 months postoperatively compared with total hip arthroplasty patients (adjusted mean difference [AMD] 0.42 points, 99% confidence interval [CI] 0.09-0.75; < 0.001) and hemiarthroplasty patients (AMD 0.39 points, 99% CI 0.04-0.74; = 0.004). However, this statistically significant difference did not reach the 7-point threshold for a minimal clinically important difference. No statistically significant differences were found in the other WOMAC scales, nor with the SF-12 PCS. In participants aged 70 years or younger, no difference was found in any of the functional outcomes at 24 months.
While stiffness is worse following internal fixation, our results show similar functional outcomes in femoral neck fracture patients undergoing modern methods of internal fixation versus arthroplasty. These results, however, may not be applicable to a younger, more active hip fracture population.
Prognostic Level II.
评估未接受再次手术的股骨颈骨折试验参与者的功能结局。
对两项随机对照试验进行二次分析。
五大洲的90家医院。
年龄在50岁及以上的股骨颈骨折患者。
关节成形术，包括全髋关节置换术和半髋关节置换术，或内固定术，包括滑动髋螺钉或多根松质骨螺钉。
西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及12项简短健康调查问卷（SF - 12）身体成分总结（PCS）。
我们的倾向评分加权模型纳入了716例关节成形术患者和549例内固定术患者的数据。与全髋关节置换术患者相比，内固定术患者术后24个月时WOMAC僵硬评分更高（导致功能更差）（调整后均值差[AMD]为0.42分，99%置信区间[CI]为0.09 - 0.75；P < 0.001），与半髋关节置换术患者相比也是如此（AMD为0.39分，99% CI为0.04 - 0.74；P = 0.004）。然而，这种具有统计学意义的差异未达到最小临床重要差异的7分阈值。在其他WOMAC量表以及SF - 12 PCS方面未发现统计学上的显著差异。在70岁及以下的参与者中，24个月时的任何功能结局均未发现差异。
虽然内固定术后僵硬情况更差，但我们的结果表明，接受现代内固定方法与关节成形术的股骨颈骨折患者的功能结局相似。然而，这些结果可能不适用于更年轻、活动度更高的髋部骨折人群。
预后II级。
