The effect of type of femoral component fixation on mortality and morbidity after hip hemiarthroplasty:A systematic review and meta-analysis

Background: Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. Questions/Purposes: The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. Results: The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. Conclusions: While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed

The Development of Intelligent Patient-Centric Systems for Healthcare

The delivery of healthcare is currently undergoing a major shift from a curative and reactive approach to one of proactive and preventative health management. This is further being accompanied by the fact that the digital information explosion, known as big data, has signalled a patient-centric revolution in medicine. Thus the development of intelligent patient-centric healthcare systems is becoming a dominant theme in driving new models of care. The ‘intelligent’ attribute of such models is in turn derived from complex theories and implementations of a myriad of AI and data analytics paradigms that present opportunities to discover novel methods of providing accurate patient-centred diagnosis, prognosis and management. This chapter revisits the role that AI has played in the provision of more personalised solutions and treatments, namely through the development and applications of various artificial neural networks and hidden Markov models in a wide range of clinical and healthcare services arenas