Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture?: a post hoc subgroup analysis of the HEALTH trial.
Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture?: a post hoc subgroup analysis of the HEALTH trial.
复制标题
DOI：
10.1302/2633-1462.38.bjo-2022-0074.r1
复制
发表时间：
2022-08
期刊：
影响因子：
--
通讯作者：
Schemitsch, E.
中科院分区：
文献类型：
--
作者：
Frihagen, F.;Comeau-Gauthier, M.;Axelrod, D.;Bzovsky, S.;Poolman, R.;Heels-Ansdell, D.;Bhandari, M.;Sprague, S.;Schemitsch, E.
本研究的目的是探索全髋关节置换术与半髋关节置换术（HEALTH）试验替代方案髋关节骨折评价中更适合的参与者亚组的功能结果，以确定全髋关节置换术（THA）与半髋关节置换术（HA）在该人群中是否具有优势。我们对来自HEALTH试验的更适合患者队列进行了事后探索性分析。受试者年龄超过50岁，患有低能量移位性股骨颈骨折（FNF）。最适合的参与者队列被定义为年龄在70岁或以下的参与者，被分类为美国麻醉医师协会I级或II级，骨折前独立行走，骨折前住在家里。多水平模型用于评估THA与HA对功能结局的影响。此外，对最适合的参与者队列的定义进行了敏感性分析。有143名患者被纳入最适合的队列。平均年龄为66岁（SD 4.5），103例为女性（72%）。在主要分析和敏感性分析中，未发现治疗组间存在临床相关差异。该分析发现，在最健康患者的亚组分析中，HA和THA在置换低能量FNF两年内的功能结局无差异。这些发现表明，在损伤后早期，很少有50岁以上的患者以具有临床意义的方式从THA与HA中获益。引用这篇文章：Bone Jt Open 2022;3（8）：611-617。
The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed. There were 143 patients included in the fittest cohort. Mean age was 66 years (SD 4.5) and 103 were female (72%). No clinically relevant differences were found between the treatment groups in the primary and sensitivity analyses. This analysis found no differences in functional outcomes between HA and THA within two years of displaced low-energy FNF in a subgroup analysis of the fittest HEALTH patients. These findings suggest that very few patients above 50 years of age benefit in a clinically meaningful way from a THA versus a HA early after injury. Cite this article: Bone Jt Open 2022;3(8):611–617.