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Comment & Response |

Hip Fracture Surgery vs Elective Total Hip Replacement

David Metcalfe, LLB, MSc, MRCS1; Daniel C. Perry, PhD, FRCS (Orth)2; Matthew L. Costa, PhD, FRCS (Orth)3
[+] Author Affiliations
1Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts
2Institute of Translational Research, University of Liverpool, Liverpool, United Kingdom
3Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
JAMA. 2016;315(9):941-942. doi:10.1001/jama.2015.17852.
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To the Editor In an observational study, Dr Le Manach and colleagues1 used a 1:1 matching technique and found that the relative risk of in-hospital mortality was higher for patients with hip fracture than those undergoing elective total hip replacement. The authors concluded that this difference could not be adequately explained by patient characteristics and may represent “physiologic mechanisms, such as acute stress and inflammatory states resulting from the fractures.”1 However, this conclusion is difficult to justify given the large differences between the elective and trauma populations. Patients undergoing elective total hip replacement are selected for their suitability to undergo a major operation, whereas hip fractures are typically a consequence of physiological deterioration (osteoporosis and falling).


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March 1, 2016
Yannick Le Manach, MD, PhD; Gary S. Collins, PhD; P. J. Devereaux, MD, PhD
1Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
2Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
JAMA. 2016;315(9):942-943. doi:10.1001/jama.2015.17861.
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