JBJS Webinar June 28–Femoral Neck Fractures: The THA vs Hemi Toss-Up
Consulting with their patients, orthopaedic surgeons make many decisions each day by weighing the best evidence available. One frequent—and controversial—decision is how best to treat displaced femoral neck fractures, a common injury among elderly patients.
Often this choice comes down to hemiarthroplasty (HA) or total hip arthroplasty (THA). The preponderance of evidence suggests that outcomes from both procedures are nearly equivalent. On Monday, June 28, 2021 at 8 pm EDT, JBJS will host a complimentary 1-hour webinar delving into the most recent findings about this dilemma.
Mohit Bhandari, MD, PhD will present findings from a 2020 Level-I meta-analysis of 16 randomized controlled trials. Functional outcomes and 5-year rates of revision and dislocation were similar between groups. THA eked out a small advantage in health-related quality of life, and HA yielded minor reductions in operative time.
Bheeshma Ravi, MD, PhD will discuss data comparing the 2 procedures in terms of complications and costs. Based on findings from this propensity score-matched analysis, the nod goes to THA, with lower 1-year rates of revision surgery and lower health-care costs.
Moderated by Bassam A. Masri, MD, FRCSC, the webinar will feature expert commentaries on these “neck-and-neck” findings. Pierre Guy, MD will comment on Dr. Bhandari’s paper, and Kelly Lefaivre, MD will weigh in on Dr. Ravi’s paper.
The webinar will conclude with a 15-minute live Q&A session during which attendees can ask questions of all the panelists.
Seats are limited–so Register Today!
CME credit will be available for surgeons and PAs attending this event live for a minimum of 50 minutes. Directions to claim your CME credit will be sent out within 48 hours of the broadcast.
Single-Shot HA vs Steroid: Similar Outcomes at 6 Months
Orthopaedists frequently treat knee osteoarthritis with hyaluronic acid (HA) or corticosteroid injections, but which works better?
The 99 patients in a double-blinded randomized controlled trial by Tammachote et al. in the June 1, 2016 Journal of Bone & Joint Surgery received a single intra-articular injection of either 6 mL of hylan G-F 20, or 1 mL of 40-mg triamcinolone acetonide plus 5 mL of 1% lidocaine. At the six-month follow-up, both groups experienced significant and similar improvements in knee pain, function, and range of motion, without complications. But there were short-term distinctions: Triamcinolone relieved pain better and faster in the first week, after which the effect became similar to that of HA. Similarly, triamcinolone provided better functional improvement than HA at two weeks post-injection, but the effects of the two drugs were not statistically distinguishable after that.
In commenting on this study, Paul Levin, MD, says that its findings “support the [AAOS] clinical practice guideline of a strong recommendation against the use of hyaluronic acid.” He goes on to do a quick cost analysis showing that if 1.2 million people received a single cortisone injection (approximately $10 each) and another 1.2 million people received a single HA injection (per-injection prices ranging from $250 to more than $1000), the yearly medication cost would be $300 million to $1.2 billion for HA, versus $12 million for corticosteroid.
Dr. Levin says explaining both clinical and cost considerations to patients can be challenging. “It is easier, more efficient, and less acrimonious to comply with our patient’s request for [HA],” he writes. But he reminds orthopaedists that “bioethical principles along with the concept of shared decision-making do require a physician to spend the necessary time to educate his or her patients.”
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