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Revisiting the landmark RCT comparing total hip arthroplasty and hemiarthroplasty for displaced hip fractures. |
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The two main surgical options for displaced hip fractures are 1) hemiarthroplasty, or 2) total hip arthroplasty.
The THA was generally thought to provide better function and quality of life.
However, its not without its concerns: mainly the risk of dislocation, and subsequently, the need for secondary operations.
For this reason, its not been clear which one is truly superior.
To settle the debate, enter: The HEALTH Trial.
Published in the New England Journal of Medicine in 2019, the HEALTH Investigators randomized 1,495 patients with displaced femoral neck fractures to receive one of the two procedures.
After 2 years, they found:
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Minimal difference in the rate of unplanned secondary procedures -- although they were more frequent early on in the THA group, and later on in the hemiarthroplasty group.
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Superior function in THA group -- but not good enough to be clinically important.
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A higher risk of dislocation/hip instability in the THA group (HR 2.00 [0.97–4.09])
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A higher risk of serious adverse events in the THA group (HR 1.16 [0.90–1.51])
Hemi-arthroplasty held its own -- and in settings where THA is not easily accessible, or cost is prohibitive, its a great option.
The HEALTH Trial is a quintessential example of the ability of high-quality orthopaedic RCTs to change and inform practice. |
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Full Analysis → |
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RCT on a new procedure -- the anterior cervical X-shaped corpectomy and fusion -- promises to double the success rate. |
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The classic procedure for decompression of the cervical spinal cord is the anterior cervical corpectomy and fusion (ACCF).
While its decompressive effects are better than a simple discectomy, it does have greater tissue disruption -- and subsequently a greater risk of complications.
Recently, a novel procedure -- the anterior cervical X-shaped corpectomy and fusion (ACXF) -- promises to rectify its limitations and improve patient outcomes.
A recent RCT of 86 patients with cervical spondylotic myelopathy aimed to assess its efficacy and found:
Almost twice a high success rate.
Lower incidence of adverse events, dysphagia, and implant subsidence.
Less drainage volume and duration.
A large multi-center study is needed to confirm its efficacy. But there is clear promise with the ACXF procedure.
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Read the Article → |
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In athletes, we focus a lot on getting injured players back on the pitch -- even if it requires surgery, and even if it costs a little more.
But that type of reasoning is often not applied to the average humeral shaft fracture patient.
In this episode of the OrthoJoe podcast, Mo & Marc sit down with Dr Bradley Petrisor, surgeon and professor at McMaster University, about a recent cost-effectiveness analyses which found that surgery can accelerate recovery, return to work, and early function, making it more cost-effective from a societal perspective.
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Watch Now → |
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Use of Intraoperative Vancomycin Powder in Orthopaedic Trauma — In adult patients undergoing orthopaedic trauma surgery, does the addition of intraoperative intrawound powdered vancomycin to standard systemic antibiotic prophylaxis, compared with standard systemic antibiotic prophylaxis alone, reduce the incidence of SSIs including gram-positive and gram-negative infections?
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Platelet-Rich Plasma Versus Corticosteroid Injection in Patients With Primary Frozen Shoulder —In patients with primary frozen shoulder in the freezing stage, does ultrasound-guided PRP injection combined with physical therapy, compared with corticosteroid injection combined with physical therapy or normal saline injection combined with physical therapy, improve pain, disability, range of motion, and quality of life?
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Fixed- vs. Adjustable-loop Suspensory Fixation in Anterior Cruciate Ligament Reconstruction — In patients undergoing hamstring autograft ACLR, does adjustable-loop femoral suspensory fixation result in equivalent objective knee laxity and patient-reported outcomes compared with fixed-loop fixation?
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FastTrack — what your peers are reading across the network
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