scholarly journals Cemented versus uncemented arthroplasty for the management of femoral neck fractures in the elderly

2020 ◽  
Author(s):  
Lang Li ◽  
Xiaodong Yang ◽  
Jun Jiang ◽  
Lei Yang ◽  
Fei Xing ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Older Patients ◽  
Meta Analysis ◽  
Operation Time ◽  
Cochrane Collaboration ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Controlled Trials ◽  
Cemented Arthroplasty ◽  
The Cochrane Collaboration

Abstract Background Hemiarthroplasty and total hip arthroplasty (TKA) are commonly used to treat unstable femoral neck fractures in older patients. However, there is no consensus on the use of cement during hemiarthroplasty and TKA. Previous reviews on this subject included small number of studies and lacked evidence grading of outcomes. In this study, we aimed to compare the outcomes of cemented and uncemented arthroplasty for the treatment of femoral neck fractures in older patients. Methods A meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using online databases (Pubmed, Cochrane Central Register of Controlled Trials, and Ovid). The quality of the included studies was assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Prospective cohort studies and randomized controlled trials (RCT) of cemented arthroplasty versus uncemented arthroplasty for treatment of femoral neck fractures were analyzed using Review Manager (version 5.2) software. Results Sixteen studies were included in the meta-analysis. Cemented arthroplasty was found to be superior to uncemented arthroplasty with respect to reoperation rate, complications related to prosthesis, residual pain, and operation time. There were no significant between-group differences with respect to local and general complications, duration of hospital stay, hip function, and mortality. Conclusion Compared with cemented arthroplasty, uncemented arthroplasty was associated with a greater risk of complications related to prosthesis, reoperation rate, residual pain, and longer operation time. However, the results of this meta-analysis should be interpreted cautiously owing to some limitations. Further studies are required to provide more robust evidence.

scholarly journals The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shuai Cui ◽  
Dehui Wang ◽  
Xuejie Wang ◽  
Zehui Li ◽  
Wenlai Guo
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Replacement ◽  
Operation Time ◽  
The Elderly ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled

Abstract Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

scholarly journals Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients

2019 ◽  
Vol 5 (3) ◽  
pp. 458
Author(s):  
Nikil Sanaba Paramesh ◽  
Usman Taufiq
Keyword(s):  
Femoral Neck ◽  
Blood Loss ◽  
Elderly Patients ◽  
Operation Time ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Intraoperative Blood Loss ◽  
Cerebrovascular Complications ◽  
Uncemented Hemiarthroplasty ◽  
Hip Function

<p class="abstract"><strong>Background:</strong> Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.</p><p class="abstract"><strong>Methods:</strong> We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p&lt;0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p&lt;0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p&lt;0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.</p><p class="abstract"><strong>Conclusions:</strong> Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.</p>

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Operation Time ◽  
Bile Leakage ◽  
Reoperation Rate ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

scholarly journals Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 33 ◽  
Author(s):  
Mohamed S.A. Shehata ◽  
Ahmed Abdelal ◽  
Sami Salahia ◽  
Hussien Ahmed ◽  
Muhammad Shawqi ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Hip Pain ◽  
Displaced Femoral Neck Fractures ◽  
Hip Function ◽  
Austin Moore ◽  
Better Than

Introduction: Thompson and Austin Moore prostheses have been commonly used in hemiarthroplasties for displaced femoral neck fractures. There has been considerable debate about which of these prostheses is preferred. The purpose of this meta-analysis was to compare historical data for clinical outcomes of cemented Thompson and uncemented Austin Moore hemiarthroplasty in displaced femoral neck fractures. Methods: We searched Medline via PubMed, Cochrane Central, Scopus, Ovid and Web of Science for relevant articles up to February 2019. The included outcomes measured were hip function, hip pain, implant-related complications, surgical complications, reoperation rate and hospital stay. The data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) between the two compared groups in a meta-analysis model. Results: Ten studies (four RCTs and six observational studies) with a total of 4378 patients were included in the final analysis. The pooled RR showed that the Thompson group was associated with a lower incidence of postoperative hip pain (RR = 0.66, 95% CI [0.54, 0.80]), lesser reoperation rate (RR = 0.46, 95% CI [0.24, 0.88]), lesser intraoperative fractures (RR = 0.15, 95% CI [0.09, 0.25]), but a longer operative time (MD = 12.04 min, 95% CI [2.08, 22.00]) in comparison to the Austin Moore group. The effect estimate did not favour either group in terms of hip function, periprosthetic fractures, prosthetic dislocations, wound infection, mortality and hospital stay. Conclusion: Evidence shows that Thompson hemiarthroplasty is better than Austin Moore hemiarthroplasty in terms of hip pain, reoperation rate and intraoperative fractures. Whereas the postoperative hip function is equivalent, these results could be considered when assessing the outcomes in modern hips.

scholarly journals Study protocol: HipSTHeR - a register-based randomised controlled trial – hip screws or (total) hip replacement for undisplaced femoral neck fractures in older patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Olof Wolf ◽  
Pontus Sjöholm ◽  
Nils P. Hailer ◽  
Michael Möller ◽  
Sebastian Mukka
Keyword(s):  
Randomised Controlled Trial ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Older Patients ◽  
Controlled Trial ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Patient Reported ◽  
Secondary Endpoints ◽  
Randomised Controlled

Abstract Background Femoral neck fractures (FNFs), which are common in the older population, are associated with high mortality and morbidity. Some 20% of FNFs are undisplaced (uFNFs). The routine surgical procedure for uFNFs is internal fixation (IF) with 2–3 screws/pins with a reported reoperation rate in older patients (age ≥ 75 years) of up to 21%. The reoperation rate for hemiarthroplasties for displaced fractures is lower than for undisplaced fractures operated with IF. This study will aim to determine whether the outcome for older patients with an uFNF can be improved by replacing the hip instead of preserving it. Methods A national multicentre, register-based, randomised controlled trial (rRCT) will be conducted. For this trial, 1440 patients, ≥75 years with an acute uFNF, will be allocated. Eligible patients will be identified by the Swedish Fracture Register (SFR) platform, which will notify the admitting orthopaedic surgeon of eligibility. After informed consent has been given and documented, patients will be randomised to either IF (control group) or arthroplasty (intervention group) within the SFR platform. Injury mechanism, fracture classification, date of injury, and type of treatment are registered in the SFR. Type and brand of arthroplasty, surgical approach, and fixation are obtained from the Swedish Hip Arthroplasty Register (SHAR). The study cohort from the SFR will be cross-checked with the National Patient Register and the SHAR for outcome variables at 2, 5, and 10 years. The primary outcome will be a composite variable comprising reoperation rate and mortality at 2 years postoperatively. Secondary endpoints will include reoperation rate and mortality as stand-alone variables. In addition, secondary endpoints will be patient-reported outcomes as measured by the Short Musculoskeletal Functional Assessment questionnaire at 1 year postoperatively as routinely collected within the SFR. Further secondary endpoints will include the occurrence of adverse events such as pneumonia, stroke or myocardial infarction and evaluation of the external validity of the study. Discussion This large, multicentre, register-based randomised controlled trial could potentially shift the treatment of uFNFs in older patients towards primary hip arthroplasty in order to improve the outcome. Trial registration The trial is registered at www.clinicaltrials.gov (NCT03966716); May 29, 2019.

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