This study evaluated variation in the surgical treatment of stable (A1) and unstable (A2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (IMN) versus sliding hip screw (SHS)). A total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type A1 and A2 trochanteric hip fractures and indicated their preferred treatment: IMN or SHS. The management of Type A3 (reverse obliquity) trochanteric fractures was not evaluated. Agreement between surgeons was calculated using multirater kappa. Multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant.Aims
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A lot of discussion persists whether obesity negatively influences the outcome of hip arthroplasty. Current literature does not answer this question, since manuscripts showing a worse outcome and those showing a similar outcome can both be found. We performed a meta-analysis with the primary research question whether obesity has a negative influence on short and long term outcome of total hip arthroplasty. A search of the literature was performed and studies comparing the outcome of hip arthroplasty in different weight groups were included. Methodology of the included studies was scored according to the Cochrane guidelines. Data extraction and pooling of the data was performed. For continuous data a weighted mean difference and for dichotomous variables a weighted Odds ratio was calculated. Heterogeneity was calculated using I2 statistics.Background
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