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John F Forbes - One of the best experts on this subject based on the ideXlab platform.
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randomized comparison of reduction and fixation bipolar Hemiarthroplasty and total hip arthroplasty treatment of displaced intracapsular hip fractures in healthy older patients
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: J F Keating, Adrian Grant, M Masson, Neil W Scott, John F ForbesAbstract:Background: Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients. The aim of this investigation was to determine the functional, clinical, and resource consequences of three different types of surgical treatment. Methods: The study was a multicenter randomized controlled trial. Reduction and fixation was compared with bipolar Hemiarthroplasty with cement and total hip replacement with cement. Participating surgeons elected to randomize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar Hemiarthroplasty. Functional outcomes were measured with a hip-rating questionnaire and the EuroQol health status measure. Clinical outcomes included mortality and complications. The direct health service costs were compared. Participants were followed up for two years. Results: Two hundred and seven patients were randomized to be treated with one of the three operations, and ninety-one were randomized to be treated with either fixation or bipolar Hemiarthroplasty. There were no differences in the mortality rates among the treatment groups. The rate of secondary surgery was highest in the fixation group (39% compared with 5% in the group treated with bipolar Hemiarthroplasty and 9% in the group treated with total hip replacement). The fixation group had the worst hip-rating-questionnaire and EuroQol scores at four and twelve months. The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups. Although fixation was initially the least costly procedure, this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions. Conclusions: Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar Hemiarthroplasty. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.
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displaced intracapsular hip fractures in fit older people a randomised comparison of reduction and fixation bipolar Hemiarthroplasty and total hip arthroplasty
Health Technology Assessment, 2005Co-Authors: J F Keating, Adrian Grant, M Masson, Neil W Scott, John F ForbesAbstract:Abstract To compare internal fixation, bipolar Hemiarthroplasty and total hip arthroplasty for the management of displaced subcapital fracture of the hip in previously fit patients of 60 years or older. A prospective randomised clinical trial. This multicentre trial was carried out in 11 Scottish hospitals with acute orthopaedic trauma units. The participants were 298 previously fit patients of 60 years or older with displaced subcapital hip fractures. The three surgical interventions for comparison were reduction and fixation, bipolar Hemiarthroplasty and total arthroplasty (total hip replacement). Participating surgeons elected to randomise patients either among all three types of operation (three-way randomisation) or just between fixation and Hemiarthroplasty (two-way randomisation). Clinical outcomes were mortality rates, reoperation rates and the complication rates associated with each procedure. Functional outcome was measured using a hip specific questionnaire [Johanson Hip Rating Questionnaire (HRQ)] and a general health status questionnaire [EuroQol 5 Dimensions (EQ-5D)]. Economic analysis compared the costs in the randomised groups of hospital treatment for the initial and subsequent admissions for up to 2 years. Altogether, 207 patients were randomised among all three trial operations, and 91 between just fixation and bipolar Hemiarthroplasty. There were no statistically significant differences in clinical outcomes, but confidence intervals (CIs) were wide. At 2 years fixation failure reached 37% among those allocated fixation and 39% had undergone further surgery. Further surgery rates after Hemiarthroplasty and total hip replacement were 5% and 9%, respectively. The group allocated fixation had significantly worse HRQ and EQ-5D scores than both arthroplasty groups at 4 and 12 months. At 24 months the results still favoured arthroplasty, but the overall HRQ and EQ-5D scores were no longer statistically significant. Total hip replacement had the best patient-assessed outcome scores. At 24 months the overall HRQ and EQ-5D scores for total hip replacement were significantly better than for Hemiarthroplasty. The mean costs for the initial episode ranged from 6384 pounds Sterling for fixation to 7633 pounds Sterling for total hip replacement. The cost differences were largely due to differences in theatre costs and the cost of prostheses and hardware. The cumulative cost over 2 years of Hemiarthroplasty was around 3000 pounds Sterling lower than for fixation (95% CI 1227 pounds Sterling to 7192 pounds Sterling). Compared with total hip replacement, both fixation and Hemiarthroplasty were characterised by increased costs arising from hip-replacement admissions. When total (initial episode and subsequent hip-related admissions) hip-related costs are compared, total hip replacement conferred a cost advantage of around 3000 pounds Sterling per patient (versus Hemiarthroplasty, 95% CI -pounds Sterling 1400 to 7420 pounds Sterling). In fit, older patients the results of the study show a clear advantage for arthroplasty over fixation; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery. The results suggest that total hip replacement has long-term advantages over bipolar Hemiarthroplasty, but these findings are less definite. This study provided support for the use of total hip replacement to treat displaced intracapsular hip fractures in fit, older patients. A larger trial comparing total versus Hemiarthroplasty for these fractures could help to verify these findings. It would also be useful to know whether the findings of this study apply to patients aged 60 years or less who are usually treated with reduction and fixation. A clinical trial comparing arthroplasty versus fixation in patients older than 40 years would be a logical extension of the current study.
G C Bannister - One of the best experts on this subject based on the ideXlab platform.
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total hip replacement and Hemiarthroplasty in mobile independent patients with a displaced intracapsular fracture of the femoral neck a seven to ten year follow up report of a prospective randomised controlled trial
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: P Avery, R Baker, Michael Walton, J C Rooker, B Squires, M F Gargan, G C BannisterAbstract:We reviewed the seven- to ten-year results of our previously reported prospective randomised controlled trial comparing total hip replacement and Hemiarthroplasty for the treatment of displaced intracapsular fracture of the femoral neck. Of our original study group of 81 patients, 47 were still alive. After a mean follow up of nine years (7 to 10) overall mortality was 32.5% and 51.2% after total hip replacement and Hemiarthroplasty, respectively (p = 0.09). At 100 months postoperatively a significantly greater proportion of Hemiarthroplasty patients had died (p = 0.026). Three hips dislocated following total hip replacement and none after Hemiarthroplasty. In both the total hip replacement and Hemiarthroplasty groups a deterioration had occurred in walking distance (p = 0.02 and p There was lower mortality (p = 0.013) and a trend towards superior function in patients with a total hip replacement in the medium term.
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total hip arthroplasty and Hemiarthroplasty in mobile independent patients with a displaced intracapsular fracture of the femoral neck a randomized controlled trial
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: R P Baker, B Squires, M F Gargan, G C BannisterAbstract:Background: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. Methods: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a Hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed. Results: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the Hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the Hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p = 0.039) and had a lower (better) Oxford hip score (p = 0.033) than those in the Hemiarthroplasty group. Twenty of thirty-two living patients in the Hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the Hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the Hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component. Conclusions: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with Hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
Peter C Poon - One of the best experts on this subject based on the ideXlab platform.
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comparison of functional outcomes of reverse shoulder arthroplasty with those of Hemiarthroplasty in the treatment of cuff tear arthropathy a matched pair analysis
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Simon W Young, Cameron G Walker, Peter C PoonAbstract:Background: Rotator cuff-tear arthropathy has traditionally represented a challenge to the shoulder arthroplasty surgeon. The poor results of conventional total shoulder arthroplasty in rotator-cuff-deficient shoulders due to glenoid component loosening have led to Hemiarthroplasty being the traditional preferred surgical option. Recently, reverse total shoulder arthroplasty has gained increasing popularity because of a clinical perception of an improved functional outcome, despite the lack of comparative data. The aim of this study was to compare the early functional results of Hemiarthroplasty with those of reverse shoulder arthroplasty in the management of cuff-tear arthropathy. Methods: The results of 102 primary hemiarthroplasties for rotator cuff-tear arthropathy were compared with those of 102 reverse shoulder arthroplasties performed for the same diagnosis. Patients were identified from the New Zealand Joint Registry and matched for age, sex, and American Society of Anesthesiologists (ASA) scores. Oxford Shoulder Scores (OSS) collected at six months postoperatively as well as mortality and revision rates were compared between the two groups. Results: There were fifty-one men and fifty-one women in each group, with a mean age of 71.6 years in the Hemiarthroplasty group and 72.6 years in the reverse shoulder arthroplasty group. The mean OSS at six months was 31.1 in the Hemiarthroplasty group and 37.5 in the reverse shoulder arthroplasty group. At the time of follow-up, there were nine revisions in the Hemiarthroplasty group and five in the reverse shoulder arthroplasty group. No difference in mortality rate was seen between the two groups. Conclusions: In this unselected population with rotator cuff-tear arthropathy, controlled for age, sex, and ASA score, reverse shoulder arthroplasty resulted in a functional outcome that was superior to that of Hemiarthroplasty. Longer-term follow-up is needed to confirm these findings. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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comparison of functional outcomes of reverse shoulder arthroplasty versus Hemiarthroplasty in the primary treatment of acute proximal humerus fracture
Anz Journal of Surgery, 2010Co-Authors: Simon W Young, Barak S Segal, Perry C Turner, Peter C PoonAbstract:Background: Treatment of complex proximal humeral fractures remains controversial. In cases where adequate open reduction and internal fixation cannot be achieved, Hemiarthroplasty has been the traditional treatment; however, clinical results have been mixed. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, and this study aimed to compare the functional results of RSA versus Hemiarthroplasty in patients with acute proximal humeral fracture. Methods: Ten patients with acute proximal humerus fractures unsuitable for internal fixation (mean age 77) who underwent RSA for acute proximal humerus fracture unsuitable for internal fixation against the outcomes of 10 patients (mean age 75) who had previously undergone Hemiarthroplasty for the same indication. Functional scores and radiographic outcomes were assessed at 22–44 months follow up. Results: At follow up the mean American Shoulder and Elbow Scorev score was 65 (range 40–88) in the RSA group and 67 (26–100) in the Hemiarthroplasty group. Mean Oxford Shoulder scores were 29 (15–56) and 22 (12–34), respectively. Mean forward elevation was 115 degrees (range 45–140 degrees) and active external rotation was 49 degrees (5–105 degrees) in the RSA group, versus 108 degrees (50–180 degrees) and 48 degrees (10–90 degrees) in the Hemiarthroplasty group. No statistically significant differences in outcome scores or range of motion were seen. Conclusion: In these early results, the anticipated functional gains of RSA over Hemiarthroplasty were not realized, suggesting the use of RSA for treatment of proximal humeral fractures should remain guarded. Larger prospective trials are necessary to identify the optimal management of patients in this situation.
J F Keating - One of the best experts on this subject based on the ideXlab platform.
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randomized comparison of reduction and fixation bipolar Hemiarthroplasty and total hip arthroplasty treatment of displaced intracapsular hip fractures in healthy older patients
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: J F Keating, Adrian Grant, M Masson, Neil W Scott, John F ForbesAbstract:Background: Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients. The aim of this investigation was to determine the functional, clinical, and resource consequences of three different types of surgical treatment. Methods: The study was a multicenter randomized controlled trial. Reduction and fixation was compared with bipolar Hemiarthroplasty with cement and total hip replacement with cement. Participating surgeons elected to randomize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar Hemiarthroplasty. Functional outcomes were measured with a hip-rating questionnaire and the EuroQol health status measure. Clinical outcomes included mortality and complications. The direct health service costs were compared. Participants were followed up for two years. Results: Two hundred and seven patients were randomized to be treated with one of the three operations, and ninety-one were randomized to be treated with either fixation or bipolar Hemiarthroplasty. There were no differences in the mortality rates among the treatment groups. The rate of secondary surgery was highest in the fixation group (39% compared with 5% in the group treated with bipolar Hemiarthroplasty and 9% in the group treated with total hip replacement). The fixation group had the worst hip-rating-questionnaire and EuroQol scores at four and twelve months. The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups. Although fixation was initially the least costly procedure, this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions. Conclusions: Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar Hemiarthroplasty. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.
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displaced intracapsular hip fractures in fit older people a randomised comparison of reduction and fixation bipolar Hemiarthroplasty and total hip arthroplasty
Health Technology Assessment, 2005Co-Authors: J F Keating, Adrian Grant, M Masson, Neil W Scott, John F ForbesAbstract:Abstract To compare internal fixation, bipolar Hemiarthroplasty and total hip arthroplasty for the management of displaced subcapital fracture of the hip in previously fit patients of 60 years or older. A prospective randomised clinical trial. This multicentre trial was carried out in 11 Scottish hospitals with acute orthopaedic trauma units. The participants were 298 previously fit patients of 60 years or older with displaced subcapital hip fractures. The three surgical interventions for comparison were reduction and fixation, bipolar Hemiarthroplasty and total arthroplasty (total hip replacement). Participating surgeons elected to randomise patients either among all three types of operation (three-way randomisation) or just between fixation and Hemiarthroplasty (two-way randomisation). Clinical outcomes were mortality rates, reoperation rates and the complication rates associated with each procedure. Functional outcome was measured using a hip specific questionnaire [Johanson Hip Rating Questionnaire (HRQ)] and a general health status questionnaire [EuroQol 5 Dimensions (EQ-5D)]. Economic analysis compared the costs in the randomised groups of hospital treatment for the initial and subsequent admissions for up to 2 years. Altogether, 207 patients were randomised among all three trial operations, and 91 between just fixation and bipolar Hemiarthroplasty. There were no statistically significant differences in clinical outcomes, but confidence intervals (CIs) were wide. At 2 years fixation failure reached 37% among those allocated fixation and 39% had undergone further surgery. Further surgery rates after Hemiarthroplasty and total hip replacement were 5% and 9%, respectively. The group allocated fixation had significantly worse HRQ and EQ-5D scores than both arthroplasty groups at 4 and 12 months. At 24 months the results still favoured arthroplasty, but the overall HRQ and EQ-5D scores were no longer statistically significant. Total hip replacement had the best patient-assessed outcome scores. At 24 months the overall HRQ and EQ-5D scores for total hip replacement were significantly better than for Hemiarthroplasty. The mean costs for the initial episode ranged from 6384 pounds Sterling for fixation to 7633 pounds Sterling for total hip replacement. The cost differences were largely due to differences in theatre costs and the cost of prostheses and hardware. The cumulative cost over 2 years of Hemiarthroplasty was around 3000 pounds Sterling lower than for fixation (95% CI 1227 pounds Sterling to 7192 pounds Sterling). Compared with total hip replacement, both fixation and Hemiarthroplasty were characterised by increased costs arising from hip-replacement admissions. When total (initial episode and subsequent hip-related admissions) hip-related costs are compared, total hip replacement conferred a cost advantage of around 3000 pounds Sterling per patient (versus Hemiarthroplasty, 95% CI -pounds Sterling 1400 to 7420 pounds Sterling). In fit, older patients the results of the study show a clear advantage for arthroplasty over fixation; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery. The results suggest that total hip replacement has long-term advantages over bipolar Hemiarthroplasty, but these findings are less definite. This study provided support for the use of total hip replacement to treat displaced intracapsular hip fractures in fit, older patients. A larger trial comparing total versus Hemiarthroplasty for these fractures could help to verify these findings. It would also be useful to know whether the findings of this study apply to patients aged 60 years or less who are usually treated with reduction and fixation. A clinical trial comparing arthroplasty versus fixation in patients older than 40 years would be a logical extension of the current study.
Alexandra Kirkley - One of the best experts on this subject based on the ideXlab platform.
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quality of life outcome following Hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis a prospective randomized trial
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: Ian K Y Lo, Robert Litchfield, Sharon Griffin, Ken Faber, Stuart D Patterson, Alexandra KirkleyAbstract:Background: Both total shoulder arthroplasty and Hemiarthroplasty have been used commonly to treat severe osteoarthritis of the shoulder; however, their effect on disease-specific quality-of-life outcome is unknown. The purpose of this study was to compare the quality-of-life outcome following Hemiarthroplasty with that following total shoulder arthroplasty in patients with osteoarthritis of the shoulder. Methods: Forty-two patients with a diagnosis of osteoarthritis of the shoulder were randomized to receive a Hemiarthroplasty or a total shoulder arthroplasty. One patient died, and all others were evaluated preoperatively and at six weeks and three, six, twelve, eighteen, and twenty-four months postoperatively with use of a standardized format including a disease-specific quality-of-life measurement tool (Western Ontario Osteoarthritis of the Shoulder [WOOS] index), general shoulder rating scales (University of California at Los Angeles [UCLA] shoulder scale, Constant score, and American Shoulder and Elbow Surgeons [ASES] evaluation form), general pain scales (McGill pain score and visual analogue scale), and a global health measure (Short Form-36 [SF-36]). When a patient required revision of a Hemiarthroplasty to a total shoulder arthroplasty, the last score before he or she “crossed over” was used for the analysis. Results: Significant improvements in disease-specific quality of life were seen two years after both the total shoulder arthroplasties and the hemiarthroplasties. There were no significant differences in quality of life (WOOS score) between the group treated with total shoulder arthroplasty and that treated with Hemiarthroplasty (90.6 ± 13.2 and 81.5 ± 24.1 points, respectively; p = 0.18). The other outcome measures demonstrated similar findings. Two patients in the Hemiarthroplasty group crossed over to the other group by undergoing a revision to a total shoulder arthroplasty because of glenoid arthrosis. Conclusions: Both total shoulder arthroplasty and Hemiarthroplasty improve disease-specific and general quality-of-life measurements. With the small number of patients in our study, we found no significant differences in these measurements between the two treatment groups. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
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a comparison of pain strength range of motion and functional outcomes after Hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder a systematic review and meta analysis
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: Dianne Bryant, Gordon H Guyatt, Robert Litchfield, Michael Sandow, Gary M Gartsman, Alexandra KirkleyAbstract:Background: A systematic review of the literature was performed to estimate the impact of Hemiarthroplasty compared with total shoulder arthroplasty on function and range of motion in patients suffering from osteoarthritis of the shoulder. Methods: We conducted an electronic search for relevant studies published in any language from 1966 to 2004, a manual search of the proceedings from five major orthopaedic meetings from 1995 to 2003, and a review of the reference lists from potentially relevant studies. Four randomized clinical trials, with similar eligibility criteria and surgical techniques, that compared Hemiarthroplasty and total shoulder arthroplasty for the treatment of primary osteoarthritis of the shoulder were found to be eligible. Authors from three of the four studies provided original patient data. Analysis of covariance focused on the two-year outcome and included a comparison of the aggregate University of California at Los Angeles shoulder score, four University of California at Los Angeles domain scores, and range of motion. Results: A total of 112 patients (fifty managed with Hemiarthroplasty and sixty-two managed with total shoulder arthroplasty), who had a mean age of sixty-eight years, were included in this analysis. A significant moderate effect was detected in the function domain of the University of California at Los Angeles shoulder score (p < 0.001) in favor of total shoulder arthroplasty (mean [and standard deviation], 8.1 ± 0.3) compared with Hemiarthroplasty (mean, 6.6 ± 0.3). A significant difference in the pain score was found in favor of the total shoulder arthroplasty group (p < 0.0001). However, the large degree of heterogeneity (p = 0.006, I2 = 80.2%) among the studies decreased our confidence that total shoulder arthroplasty provides a true, consistent benefit with regard to pain. There was a significant difference in the overall change in forward elevation of 13° (95% confidence interval, 0.5° to 26°) in favor of the total shoulder arthroplasty group (p = 0.008). Conclusions: At a minimum of two years of follow-up, total shoulder arthroplasty provided better functional outcome than Hemiarthroplasty for patients with osteoarthritis of the shoulder. Since continuous degeneration of the glenoid after Hemiarthroplasty or glenoid loosening after total shoulder arthroplasty may affect the eventual outcome, longer-term (five to ten-year) results are necessary to determine whether these findings remain consistent over time. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.