PROJECT PLAN
TOPIC:
‘Fix and Replace’ – an emerging paradigm for treating acetabular fractures: A systematic review of literature and meta-analysis to evaluate classification and functional outcome of patients.
RESEARCH QUESTION:
How does ‘Fix and Replace(F+R)’ (including or not hip replacement after failed acetabular ORIF) compare with conventional THR/THA (Total hip replacement/arthroplasty)?
AIMS:
1. To determine the optimum management of acetabular fractures
2. To evaluate a classification and functional outcomes.
3. To do a meta analysis of outcomes – complications, infection rate and functional outcomes.
INCLUSION AND EXCLUSION CRITERIA:
Inclusion:
1. Participants of all ages who underwent early THA post acetabular ORIF (Open reduction and internal fixation) or THA for the treatment of post-traumatic arthritis following ORIF or conservative (non-operative) management for traumatic acetabular fractures will be included.
4. Data on patient demographics and results of THA (including acute F+R + delayed F+R + THR too) – complications, patients who underwent revision and functional scores, will be collected.
(N.B : Patients who underwent fix and replace, either at the same sitting or a few days apart. These are the ‘new paradigm’ of fix and replace.
Data can be collected comparing early F+R vs delayed F+R vs Conservative + R.)
Exclusion:
1. Patients with non-traumatic fractures, peri-prosthetic fractures, or co-existing femur fractures.
5. Studies with minimal data and non-English language articles will be excluded.
PRIMARY +/- SECONDARY OUTCOMES:
Primary outcomes of interest are: patient demographics, time from acetabular fracture to THA, operative characteristics, and various outcomes following conversion arthroplasty. These outcomes will include: implant survival, need for revision, re-surgery, pooled complication rate, functional scores, and predictors of poor outcomes. The secondary aim of this study will be to compare and do a meta analysis of outcomes of delayed THR following acetabular fractures and outcomes of acetabular fractures treated with primary THR to non-traumatic primary THR.
So this means there are three groups to compare:
1. Delayed THR after failed Orif (‘delayed’ needs to be defined here)
2. Acute THR after ORIF (similarly, ‘acute’ needs to be defined as well)
3. Historic cohort of THRs for OA (Osteoarthritis)
(Its important to be very clear about these groups and how they are going to be compared and making sure they’re clearly defined. Might be worth mentioning that you’re going to be using a historic, literature based comparator here.)
DATA SOURCE AND SEARCHING STRATEGIES:
Pubmed, EMBASE, SCOPUS, RevMan and Cochrane library will be searched for articles containing the keywords ‘’fix and replace’, “acetabular”, “fracture”, “arthroplasty”, “‘failed acetabular fixation ORIF?” and “post traumatic arthritis”
DATA MANAGEMENT, REDUCTION AND SELECTION PROCESSES:
Excel spread sheet will be used for data entry. Treatment offered will be the main comparator, and the information to be gathered will include the number of patients, mean age, classification of the fracture, type of treatment, mean operating time, re-surgery, complications, post-operative rehab and functional and radiographic results.
DATA ANALYSIS PLAN:
The data will be analysed using the PRISMA reporting tool. I will aim to plot the results to visually and statistically check for heterogeneity.
SOURCES OF BIAS AND MITIGATION:
I will exclude articles with high risk of attrition bias, defined as greater than 30% of patients lost to follow-up. Any articles that fail to meet all inclusion criteria will be excluded. Conference and meeting abstracts will also be excluded. Cochrane Risk of Bias tool will be used for aid.
DETAILS OF ANY BARRIERS THAT MAY BE FACED IN IMPLEMENTING THE STUDY. HOW THEY WILL BE ADDRESSED?:
This review has limitations. All the studies identified for analysis were case series and therefore lacked a control group. In this type of review publication bias is an inherent risk and might be reflected in the studies identified. Within this age group of patients, there is an inevitable presence of heterogeneity when the different forms of treatment are compared, which is difficult to overcome given the number of studies available.
(N.B- When doing a systematic review or meta analysis, minimum case-number needs to be defined that you’ll consider including. Eg case series of 15 or 20 – you gonna include those? You can do, but up to you. Maybe worth looking at what’s out there before nailing down this number)