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Published literature findings differ from register data regarding specific hip prostheses, according to meta-analysis

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Gerold Labek

COPENHAGEN — A meta-analysis of clinical literature found that published results of hip neck fracture treatment using specific hip prostheses deviate from data acquired via a national arthroplasty register, according to Austrian investigators.

Gerold Labek, MD, presented his team’s findings at the 12th EFORT Congress 2011, here.

Further findings in the study indicate potential evidence that more stringent indications for monobloc implants could yield improved surgical outcomes.

Labek’s team performed a comprehensive literature analysis of clinical literature and register reports. Potential bias factors and validity were examined, but the purpose of the exercise to compile a summary of available data with a main criterion of revision rate indicators.

“What we have seen is that in the studies published since 2000, the outcome is significantly better than in the older studies,” Labek said. “Concerning mortality rates, on average we have mortality in the first year of 8%, and more than 50% between 1 year and 4 years. Complications are mainly dislocation, infection and pain.”

Labek said the findings point toward revision rates being “significantly underestimated” since 2000 — by a factor of 2.15, he noted, when compared with register data. Two revisions per 100 observed component years means the revision rate Labek’s group found in the registers, he added, exceeds comparative values.

“We have differences in the complications reported between several base studies and registries, so mainly complications which are independent of the surgeon are reported in clinical studies,” Labek said. “The revision rates are high with cervicocephalic implants — monobloc higher than the others — but I think there is some possibility of improvement in the outcomes by using more modular implants for total hip arthroplasty in controversial cases.”

Reference:

• Labek G, Thaler M, Agreiter M, et al. Quality of data published on the outcome after treatment of hip neck fracture with cervicocephalic hip implants. Paper #819. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.

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