Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture.

Aged Aged, 80 and over Arthroplasty, Replacement, Hip / methods Bone Cements / adverse effects Female Femoral Neck Fractures / surgery Hemiarthroplasty / adverse effects Humans Kaplan-Meier Estimate Male Periprosthetic Fractures / epidemiology Postoperative Complications / epidemiology Quality of Life Risk Factors

Journal

The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562

Informations de publication

Date de publication:
10 02 2022
Historique:
entrez: 9 2 2022
pubmed: 10 2 2022
medline: 19 2 2022
Statut: ppublish

Résumé

Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available. We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075). A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups. Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).

Sections du résumé

BACKGROUND
Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available.
METHODS
We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075).
RESULTS
A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups.
CONCLUSIONS
Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).

Identifiants

DOI: 10.1056/NEJMoa2108337 PMID: 35139272
pubmed: 35139272
doi: 10.1056/NEJMoa2108337
doi:

Substances chimiques

Bone Cements 0

Banques de données

ISRCTN
['ISRCTN18393176']

Types de publication

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

521-530

Subventions

Organisme : National Institute for Health Research
ID : PB-PG-0215-36043
Organisme : National Institute for Health Research
ID : PB-PG-1216-20021

Investigateurs

Andrew McAndrew (A)
Sunit Patil (S)
Mark Dunbar (M)
Daniel Engelke (D)
Mohammad Maqsood (M)
Konstantinos Tsitskaris (K)
Theophilus Joachim (T)
Advait Jayant Gandhe (AJ)
Ansar Mahmood (A)
Gregoris Kambouroglou (G)
Deepak Herlekar (D)
Khushroo Suraliwala (K)
Mohammad Faisal (M)
Callum Clark (C)
Vishnu Sharma (V)
Irfan Merchant (I)
Angus Kaye (A)
Andrew Grazette (A)
Shafiq Shahban (S)
Arham Qureshi (A)
Kanai Garala (K)
Lydia Jenner (L)
Mohamed Elmeligy (M)
Sammy Hanna (S)
Hemanta Das (H)
Abdul Moeed (A)
Alok Singh (A)
Suranga Gurusinghe (S)
Ashim Wokhlu (A)
Breck Lord (B)
Charlotte Lewis (C)
James Archer (J)
Omer Salar (O)
Raghunaathan Rangan (R)
Mohammed Shahid (M)
Shakir Hussain (S)
Chandramohan Sivagami Panneerselvam (CS)
Chris Bretherton (C)
Farhan Syed (F)
Ajay Chourasia (A)
Alexander Martin (A)
Imran Ullah (I)
Neal Rupani (N)
Euan Stirling (E)
John Keating (J)
Anthony Johansen (A)
Stuart White (S)
Karen May (K)
Philip Bell (P)
Michael Dewey (M)
May Cleary (M)
Alan Johnstone (A)
Ada Keding (A)

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2022 Massachusetts Medical Society.

Auteurs

Miguel A Fernandez (MA)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

Juul Achten (J)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

Nicholas Parsons (N)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

Xavier L Griffin (XL)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.
ORCID: 0000-0003-2976-7523

May-Ee Png (ME)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

Jenny Gould (J)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

Alwin McGibbon (A)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

Matthew L Costa (ML)

From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Procédures de chirurgie opératoire › Implantation de prothèse › Arthroplastie prothétique › Arthroplastie prothétique de hanche › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Technologie, industrie et agriculture › Produits manufacturés › Matériaux biomédicaux et dentaires › Polymères › Matières plastiques › Résines synthétiques › Ciments osseux › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Plaies et blessures › Traumatismes de la jambe › Fractures du fémur › Fractures de la hanche › Fractures du col fémoral › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Procédures de chirurgie opératoire › Implantation de prothèse › Arthroplastie prothétique › Hémiarthroplastie › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Estimation de Kaplan-Meier › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Plaies et blessures › Fractures osseuses › Fractures périprothétiques › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Cemented or Uncemented Hemiarthroplasty for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Cemented or Uncemented Hemiarthroplasty for...