Artroplastia total x parcial do quadril no tratamento das fraturas desviadas do colo femoral: overview das revisões sistemáticas
Data
2023-03-06
Autores
Falotico, Guilherme Guadagnini 
Orientadores
Belloti, João Carlos
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: as artroplastias de quadril para o tratamento de fraturas desviadas do colo do fêmur em adultos podem ser do tipo total ou parcial. Apesar da alta prevalência dessas fraturas e do grande número de estudos sobre o assunto, a melhor modalidade de artroplastia a ser utilizada ainda apresenta controvérsia e não foi publicada nenhuma revisão overview. Objetivo: estabelecer a melhor modalidade de artroplastia do quadril para o tratamento das fraturas desviadas do colo femoral em adultos acima de 50 anos. Métodos: quatro bases de dados eletrônicas (Pubmed, Embase, Biblioteca Cochrane e Web of Science) foram pesquisadas. Os estudos elegíveis foram revisões sistemáticas de ensaios clínicos randomizados que compararam a artroplastia total do quadril e a hemiartroplastia para o tratamento de fraturas deslocadas do colo do fêmur em adultos. Os desfechos primários foram mortalidade, função, qualidade de vida e taxa de revisão e os secundários: luxação, fratura periprotética, infecção e tempo cirúrgico. As comparações de dados dicotômicos foram relatadas como risco relativo e IC de 95%, e as comparações de resultados funcionais e de qualidade de vida relacionados à saúde foram relatadas como a diferença média e IC de 95%. Resultados: vinte revisões sistemáticas com total de 29980 pacientes foram analisadas. Os pacientes com artroplastia total do quadril tiveram menor taxa de revisão (RR 0,67, IC 95% 0,48 a 0,93; participantes = 4078; estudos = 22; I2 = 30%), melhor função (DMP 0,59, IC 95% 0,11 a 1,08; participantes = 963; estudos = 12; I2 = 87%) e melhor qualidade de vida (parcial (DM 0,05, IC 95% 0,03 a 0,08; participantes = 1240; estudos = 6; I2 = 28%). Não houve diferença quanto à luxação, infecção, fratura periprotética e mortalidade. O tempo cirúrgico foi menor na hemiartroplastia ((DM 20,46, IC 95% 12,12 a 28,80; participantes = 1493; estudos = 16; I2 = 95%). O tempo de seguimento e a idade dos pacientes não revelaram diferenças na análise de subgrupos. A certeza de evidência variou de muito baixa a alta para cada desfecho. Conclusão: A artroplastia total do quadril apresentou menor taxa de revisão (moderada certeza de evidência) e melhor qualidade de vida (alta certeza de evidência) e função (muito baixa certeza de evidência). As taxas de mortalidade, luxação, infecção e fratura periprotética foram semelhantes. O tempo cirúrgico foi em média 20 minutos menor na hemiartroplastia (baixa certeza de evidência).
Introduction: hip arthroplasties for the treatment of displaced femoral neck fractures in adults can be total replacement or hemiarthroplasty. Despite the high prevalence of these fractures and large number of studies on the topic, the best choice of arthroplasty to be used remains unclear and no overview published. Objective: The present study aims to overview the results of systematic reviews of randomized controlled trials (RCTs) comparing outcomes between total hip replacement and hemiarthroplasty for displaced femoral neck fractures in adults. Methods: Four electronic databases (Pubmed, Embase, Cochrane Library and Web of Science) and reference lists from previous reviews were researched. Eligible studies were systematic reviews of RCT that compare total hip replacement and hemiarthroplasty for treatment of displaced femoral neck fractures in adults. The primary outcomes were mortality, function, quality of life and revision rate and the secondary ones: dislocation, periprosthetic fracture, infection, and surgical time. Comparisons of dichotomous data were report as the OR and 95% CI, and comparisons of functional and health related quality of life outcomes were reported as the mean difference and 95% CI. Results: twenty systematic reviews with a total of 29980 patients were analyzed. Patients with total hip arthroplasty had a lower revision rate (RR 0.67, 95% CI 0.48 to 0.93; participants = 4078; studies = 22; I2 = 30%), better function (SMD 0.59, 95% CI 0.11 to 1.08; participants = 963; studies = 12; I2 = 87%) and better quality of life (DM 0.05, 95% CI 0.03 to 0.08; participants = 1240; studies = 6; I2 = 28%). There was no difference regarding dislocation, infection, periprosthetic fracture and mortality. Surgical time was shorter in hemiarthroplasty (DM 20.46, 95% CI 12.12 to 28, 80; participants = 1493; studies = 16; I2 = 95%). The length of follow-up and the age of the patients did not reveal differences in the subgroup analysis. The certainty of evidence varies from very low to high for each outcome. Conclusion: Total hip arthroplasty had a lower revision rate (moderate certainty of evidence) and better quality of life (high certainty of evidence) and function (very low certainty of evidence). Surgical time was on average 20 minutes shorter in hemiarthroplasty (low certainty of evidence). Mortality, dislocation, infection, and periprosthetic fracture rates were similar.
Introduction: hip arthroplasties for the treatment of displaced femoral neck fractures in adults can be total replacement or hemiarthroplasty. Despite the high prevalence of these fractures and large number of studies on the topic, the best choice of arthroplasty to be used remains unclear and no overview published. Objective: The present study aims to overview the results of systematic reviews of randomized controlled trials (RCTs) comparing outcomes between total hip replacement and hemiarthroplasty for displaced femoral neck fractures in adults. Methods: Four electronic databases (Pubmed, Embase, Cochrane Library and Web of Science) and reference lists from previous reviews were researched. Eligible studies were systematic reviews of RCT that compare total hip replacement and hemiarthroplasty for treatment of displaced femoral neck fractures in adults. The primary outcomes were mortality, function, quality of life and revision rate and the secondary ones: dislocation, periprosthetic fracture, infection, and surgical time. Comparisons of dichotomous data were report as the OR and 95% CI, and comparisons of functional and health related quality of life outcomes were reported as the mean difference and 95% CI. Results: twenty systematic reviews with a total of 29980 patients were analyzed. Patients with total hip arthroplasty had a lower revision rate (RR 0.67, 95% CI 0.48 to 0.93; participants = 4078; studies = 22; I2 = 30%), better function (SMD 0.59, 95% CI 0.11 to 1.08; participants = 963; studies = 12; I2 = 87%) and better quality of life (DM 0.05, 95% CI 0.03 to 0.08; participants = 1240; studies = 6; I2 = 28%). There was no difference regarding dislocation, infection, periprosthetic fracture and mortality. Surgical time was shorter in hemiarthroplasty (DM 20.46, 95% CI 12.12 to 28, 80; participants = 1493; studies = 16; I2 = 95%). The length of follow-up and the age of the patients did not reveal differences in the subgroup analysis. The certainty of evidence varies from very low to high for each outcome. Conclusion: Total hip arthroplasty had a lower revision rate (moderate certainty of evidence) and better quality of life (high certainty of evidence) and function (very low certainty of evidence). Surgical time was on average 20 minutes shorter in hemiarthroplasty (low certainty of evidence). Mortality, dislocation, infection, and periprosthetic fracture rates were similar.