Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle>
AimsThe 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 he...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-08-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.38.BJO-2022-0074.R1 |
| _version_ | 1798038739669221376 |
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| author | Frede Frihagen Marianne Comeau-Gauthier Daniel Axelrod Sofia Bzovsky Rudolf Poolman Diane Heels-Ansdell Mohit Bhandari Sheila Sprague Emil Schemitsch |
| author_facet | Frede Frihagen Marianne Comeau-Gauthier Daniel Axelrod Sofia Bzovsky Rudolf Poolman Diane Heels-Ansdell Mohit Bhandari Sheila Sprague Emil Schemitsch |
| author_sort | Frede Frihagen |
| collection | DOAJ |
| description | AimsThe 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.MethodsWe 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.ResultsThere 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.ConclusionThis 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. |
| first_indexed | 2024-04-11T21:44:23Z |
| format | Article |
| id | doaj.art-d345613455c4403a914b14b97ddfb455 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-04-11T21:44:23Z |
| publishDate | 2022-08-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-d345613455c4403a914b14b97ddfb4552022-12-22T04:01:28ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-08-013861161710.1302/2633-1462.38.BJO-2022-0074.R1Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle>Frede Frihagen0Marianne Comeau-Gauthier1Daniel Axelrod2Sofia Bzovsky3Rudolf Poolman4Diane Heels-Ansdell5Mohit Bhandari6Sheila Sprague7Emil Schemitsch8Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, NorwayDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaDepartment of Orthopedic Surgery, OLVG, Leiden, the NetherlandsDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, CanadaDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaDepartment of Surgery, University of Western Ontario, London, CanadaAimsThe 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.MethodsWe 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.ResultsThere 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.ConclusionThis 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.https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.38.BJO-2022-0074.R1Femoral neck fractureHealth-related quality of lifeTotal hip arthroplastyHemiarthroplastydisplaced femoral neck fracturetotal hip arthroplasty (THA) |
| spellingShingle | Frede Frihagen Marianne Comeau-Gauthier Daniel Axelrod Sofia Bzovsky Rudolf Poolman Diane Heels-Ansdell Mohit Bhandari Sheila Sprague Emil Schemitsch Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle> Bone & Joint Open Femoral neck fracture Health-related quality of life Total hip arthroplasty Hemiarthroplasty displaced femoral neck fracture total hip arthroplasty (THA) |
| title | Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle> |
| title_full | Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle> |
| title_fullStr | Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle> |
| title_full_unstemmed | Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle> |
| title_short | Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? <subtitle>a post hoc subgroup analysis of the HEALTH trial</subtitle> |
| title_sort | who if anyone may benefit from a total hip arthroplasty after a displaced femoral neck fracture subtitle a post hoc subgroup analysis of the health trial subtitle |
| topic | Femoral neck fracture Health-related quality of life Total hip arthroplasty Hemiarthroplasty displaced femoral neck fracture total hip arthroplasty (THA) |
| url | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.38.BJO-2022-0074.R1 |
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