Hip plating system yielded similar quality of life outcomes vs sliding hip screw
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Patients with trochanteric hip fractures treated with a hip plating system had similar health-related quality of life outcomes and risk of revision as patients who were treated with a sliding hip screw, according to published results.
“Both implants behave similarly and yield similar results for patients, and I think both are reasonable and appropriate treatments for ... trochanteric fractures,” Xavier L. Griffin, PhD, FRCS(Tr&Orth), of the School of Medicine and Dentistry at Queen Mary University of London and honorary consultant orthopedic surgeon at Barts Health NHS Trust, told Orthopedics Today.
Hip plate vs sliding hip screw
Griffin and his colleagues randomly assigned 1,128 patients with a trochanteric hip fracture to fracture fixation with either a sliding hip screw (n=564) or the X-Bolt Dynamic Hip Plating System (n=564; X-Bolt Orthopaedics). Researchers assessed the EuroQol-5D-5L at 4 months postoperatively as the primary outcome, while EQ-5D-5L utility at 12 months, mortality, residential status, mobility, revision surgery and radiological measures were considered secondary outcomes.
In the primary intention-to-treat analysis, researchers analyzed 437 patients in the hip plating system group and 443 patients in the sliding hip screw group. Results were compatible with a mean difference between groups being in the interval -0.013 to 0.070 in the adjusted utility index. These values were all smaller than the estimated minimum clinically important difference. Researchers found no differences in any of the secondary outcomes between the treatment groups. The hip plating and sliding hip screw groups also had similar patterns and overall risk of adverse events, according to results.
“There was no evidence of a difference [between the two treatments], but also any difference that did exist was tiny,” Griffin said.
Changes in practice
Based on these findings, orthopedic surgeons already using the sliding hip screw in their practices may not readily choose to switch to the hip plating system, Griffin said.
“If the study results had shown that the X-Bolt had performed a lot better, then I can imagine that in that case we would see people increasingly using the X-Bolt,” he said.
However, Griffin and his colleagues recommend surgeons use whichever device they feel most comfortable with in their practice.
“There are a lot of factors when you are thinking about a choice of surgical treatment,” Griffin said. “Part of it is about the instrumentation that goes with the device [and] the familiarity the rest of your staff has with the kit, because doing an operation is a big team effort. So, our recommendation was surgeons should select the [implant] that was most appropriate in their practice.”
While Griffin has concluded research into the X-Bolt Dynamic Hip Plating System, he and his colleagues continue to seek to answer questions surrounding treatment of hip fractures.
“Our World Hip Trauma Evaluation or WHiTE study has recruited over 25,000 patients over the years in a series of trials that investigate different ways of treating hip fractures. Patients have been involved in trialing a range of implants and techniques and, of course, as technology evolves, there might be new questions to ask,” Griffin said. “It’s a continuous road, but a useful road for patients to get the right treatments.
- For more information:
- Xavier L. Griffin, PhD, FRCS(Tr&Orth), can be reached at Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom; email: x.griffin@qmul.ac.uk.
Perspective
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This trial reminds surgeons that how you do the surgery and where you place the implants matters more than which implant you choose. This study joins a long line of large, well done, intertrochanteric fracture randomized controlled trials which showed no difference in outcome. Surgeons can choose nails or hip screws, long or short nails it has little influence. The most important things are good reduction, small tip-apex distance and early mobilization.
Three pearls are buried in these data: The researchers noted that surgical complications seem to be going down because hip fracture cases are being done in daytime trauma block. Also, they are going to publish a separate paper on radiographic outcomes interesting, because we know that maintenance of length (avoiding shortening) is associated with better function. Finally, there is a persistently high 35% mortality rate at 1 year.
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