背景:研究的目的是:1)评估对2023年美国国家健康与护理卓越研究所(NICE)新标准的满意度,该标准用于选择全髋关节置换术(THA)而不是半髋关节置换术(HA)和治疗移位的髋关节囊内骨折的手术建议;2)描述为什么不符合NICE标准时进行THA;3)确定对这些指南的满意度是否与改善相关。
方法:对2010年至2022年在一个三级学术中心接受THA治疗的移位性髋关节囊内骨折患者进行回顾性分析。审查了术前患者特征,以确定THA的适应症是否符合NICE标准。操作详情,围手术期并发症,重新操作,并记录手术后12个月内的关节翻修术.
结果:使用了196例患者(63%为女性;年龄67±10岁)的数据。有161个THA(82.1%)满足NICE标准。当不符合NICE标准(n=35)时,进行THA的两个最常见原因包括术前影像学骨关节炎(Tönnnis等级≥2;48.6%)和患者年龄降低(<65岁;31.5%)。对NICE标准的满意度与较少的围手术期并发症相关(0.6对37.1%;P<0.001)。再次手术(0.6对31.4%;P<0.001),和修订(0.6对28.6%;P<0.001)。最常见的翻修原因是假体周围骨折,可能继发于使用非骨水泥股骨柄(196中的171,87.2%)。
结论:对新NICE标准的满意度与改善围手术期结局相关。有必要进行进一步的研究,以确定在选择患者时是否需要考虑先前存在的髋关节骨关节炎和较年轻的年龄。
BACKGROUND: The objectives of the study were to: (1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (
THA) over hemiarthroplasty and surgical recommendations for treatment of displaced intracapsular hip fractures; (2) describe why
THA is performed when NICE criteria are not met; and (3) determine whether satisfaction with these
guidelines is associated with improved outcomes.
METHODS: A retrospective chart review of patients who had a displaced intracapsular hip fracture treated with
THA at a single tertiary academic center between 2010 and 2022 was performed. Preoperative patient characteristics were reviewed to determine if the indication for
THA met NICE criteria. Operative details, perioperative complications, reoperation, and revision arthroplasty within 12 months of surgery were recorded.
RESULTS: Data from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The 2 most common reasons for performing a THA when NICE criteria were not met (n = 35) included preoperative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer perioperative complications (0.6 versus 37.1%; P < .001), reoperations (0.6 versus 31.4%; P < .001), and revisions (0.6 versus 28.6%; P < .001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%).
CONCLUSIONS: Satisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if preexisting hip osteoarthritis and younger age merit consideration in patient selection.