Analysis/Pratices: Hip Fracture Repair and Osteoarthritis. Abstract, ExecutiveSummary, Final Report and Tables

摘要

Based on the findings from the authors observational studies, and pending thepeer review process attendant to submission of manuscripts for journal publication, the authors make the following recommendations: (1) For displaced intracapsular fractures in patients over the age of 80 years, the current practice of utilizing arthroplasty in deference to reduction and internal fixation is supported; (2) For all intracapsular fractures in patients over the age of 65 years and under the age of 80 years, and for non-displaced fractures over the age of 80 years, the use of either reduction and internal fixation or arthroplasty is supported, the decision ultimately depending upon assessment of bone quality and predicted level of post-repair activity; (3) When considering hemiarthroplasty for all intracapsular fractures in age groups, the bipolar prostheses appear to offer the advantage over the unipolar in terms of less pain and improved return of function up to 24 months post-surgery, although no differences were found in eight year revision rates. No short-term differences were noted when comparing outcomes of cemented versus non-cemented bipolars; (4) The current controversy in THR for OA centers around the selection of the articulating surface for the femoral component. The authors' analyses suggest that the totally non-cemented prosthesis, more costly in the age group over 75 years, offers no difference in short-term functional improvement or pain reduction.