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Femoral neck fracture: Minimally invasive hemiarthroplasty results in early mobilization
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August 2013
Femoral neck fracture: Minimally invasive hemiarthroplasty results in early mobilization
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach
BMC Musculoskelet Disord. 2012 Aug 8;13:141. doi: 10.1186/1471-2474-13-141.Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
60 patients with fractured femur necks undergoing bipolar hemiarthroplasty were randomized to receive the conventional Watson-Jones approach or the minimally invasive Direct Anterior Approach (DAA). The results of the study indicate that the minimally invasive direct anterior approach allows for improved early mobilization status and reduced pain when compared to the conventional Watson-Jones-Approach.
Publication Funding Details
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Funding:
Non-Industry funded
Sponsor:
University Lübeck
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
As the global population ages, there is an increasing incidence of osteoporosis related hip fractures and subsequent hip fracture complications. Early mobilization after corrective hip arthroplasty has been shown to combat the morbidity and mortality associated with hip fractures. Previous studies examining the effects of conventional and minimally invasive hip arthroplasty on mobilization resulted in conflicting results regarding hip function, pain, and mobilization. This study aimed to determine whether femoral neck fractures treated by conventional bipolar hemiarthroplasty or minimally invasive bipolar hemiarthroplasty result in differences in mobilization outcomes.
What was the principal research question?
Do femoral neck fractures treated by conventional bipolar hemiarthroplasty differ from those treated by minimally invasive hemiarthroplasty with respect to mobilization outcomes when compared 40 days after surgical treatment?
Study Characteristics
-
Population:
60 patients with fractured femur necks undergoing bipolar hemiarthroplasty.
Intervention:
Bipolar hemiarthroplasty via the minimally invasive direct anterior approach (Median age: 84 (70 to 94) years) (n=30).
Comparison:
Bipolar hemiarthroplasty via the conventional Watson-Jones-Approach (Median age: 87.5 (71 to 96) years) (n=30).
Outcomes:
Mobilization status was assessed using the 4-item abbreviation of the Barthel index; pain was assessed using a Visual Analogue Scale (VAS); implant position, femoral offset, and leg length were assessed using radiographs; blood loss was assessed using measurements of required units of packed red cells. Complications were also assessed.
Methods:
RCT: prospective; single-blinded.
Time:
40 days (outcomes assessed on day 1, 5, 16, and 40 after surgery).
What were the important findings?
- By the 5th postoperative day, the DAA group achieved a Barthel score of 20, whereas the Watson-Jones group achieved a Barthel score of 10 (p=0.009). The difference in mobilization between the two treatment groups remained significant at the final follow-up on the 40th postoperative day (p=0.013).
- There was no significant difference in postoperative pain until the 16th postoperative day in which the DAA group experienced significantly less pain than the Watson-Jones group (p=0.035). The patients in the DAA group also experienced significantly less pain than the patients in the Watson-Jones group on the 40th postoperative day (p=0.0004).
- There were no significant differences in packed red cell requirements between the patients in the DAA group and the patients in the Watson-Jones group at any point in time during the follow-up period.
- The femoral offset and leg length was not clinically different between the DAA group and the Watson-Jones group (p=0.19 and p=0.23, respectively). Normal prosthesis alignment was found in 77% of patients in the DAA group and 71.5% of patients in the Watson-Jones group.
- From the DAA group, 1 patient developed deep vein thrombosis, and 1 patient developed a wound edge necrosis at the proximal wound pole. From the Watson-Jones group, 2 patients developed deep vein thrombosis, 1 patient developed an infected haematoma, and 1 patient required 12 units of packed red cells for a unknown reason.
What should I remember most?
The data suggest that the minimally invasive direct anterior approach results in better mobilization outcomes and less pain than the conservative Watson-Jones-Approach.
How will this affect the care of my patients?
The study suggests that bipolar hemiarthroplasty via the minimally invasive direct anterior approach results in better early mobilization outcomes than bipolar hemiarthroplasty via the conservative Watson-Jones-Approach. Further research using larger sample sizes and longer follow-up periods are required to determine if improved mobilization results in fewer complications.
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