Hip Hemiarthroplasty vs Total Hip Arthroplasty for Femoral Neck Fractures: Reverse Fragility of Reoperation Rates in...

Area of Science:

• Orthopedic Surgery
• Clinical Trials Methodology
• Biostatistics

Background:

• Total hip arthroplasty (THA) and hemiarthroplasty are surgical options for femoral neck fractures.
• Studies suggest comparable reoperation rates between THA and hemiarthroplasty.
• The statistical reliability of these non-significant findings requires further investigation.

Purpose of the Study:

• To assess the statistical robustness of randomized controlled trials (RCTs) comparing reoperation rates for femoral neck fractures.
• To utilize the reverse fragility index (RFI) to evaluate the sensitivity of non-significant results to small changes in patient outcomes.

Main Methods:

• Systematic review of RCTs comparing THA and hemiarthroplasty for femoral neck fractures, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Inclusion criteria focused on studies reporting non-significant differences in reoperation rates.
• Calculation of the reverse fragility index (RFI) and analysis of patient loss to follow-up for each included study.

Main Results:

• Nine RCTs with non-significant reoperation rate differences were analyzed.
• Median reoperation rates were 7.9% for hemiarthroplasty and 5.0% for THA.
• The median RFI was 3, indicating that reversing outcomes for just 3 patients could alter the statistical significance (P < .05).
• Six of nine studies had more patients lost to follow-up than their RFI.

Conclusions:

• Clinical trial results showing non-significant reoperation rate differences between THA and hemiarthroplasty are often statistically fragile.
• The number of patients needed to change the study's conclusion was frequently less than the number lost to follow-up.
• The neutrality of these comparative studies is questionable due to their fragility.