Femoral Neck Fracture Evidence

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Marc and Mo are talking about the choice of a unipolar or bipolar prosthesis design for displaced femoral neck fractures which are treated with hemiarthroplasty. They discuss randomized clinical trials (scientific approach to control bias) vs registry data (real world). They also have a lively discourse about revision rates. If you have any comments, questions, or topics you would like us to cover, please feel free to reach out so we can read your messages and possibly answer your questions during the next episode of OrthoJOE. Talking Points: Orthoevidence article: “Unipolar vs bipolar hemiarthroplasty similar in elderly displaced femoral neck fractures in elderly individuals” Lessons from Mo’s large random control trial concerning fractures The debate about total versus hemiarthroplasty The advantage of a total hip replacement The statistics of the trial The need for a repository of data Clinical decision-making about cementification and revision Resources/Links: Farey JE, Cuthbert AR, Adie S, Harris IA. “Revision Risk After Unipolar or Bipolar Hemiarthroplasty for Femoral Neck Fractures: An Instrumental Variable Analysis of 62,875 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.” J Bone Joint Surg Am. 2021 Feb 3;103(3):195-204. doi: 10.2106/JBJS.20.00486. PMID: 33208595. https://europepmc.org/article/med/33208595  HEALTH Investigators, Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfán E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky S, Heels-Ansdell D, Thabane L, Walter SD, Devereaux PJ. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med. 2019 Dec 5;381(23):2199-2208. doi: 10.1056/NEJMoa1906190. Epub 2019 Sep 26. PMID: 31557429. https://pubmed.ncbi.nlm.nih.gov/31557429/  Orthoevidence: “Unipolar vs bipolar hemiarthroplasty similar in elderly displaced femoral neck fractures in elderly individuals” https://myorthoevidence.com/AceReports/Report/8399