Uncemented vs Cemented Hemiarthroplasty for Hip Fracture —Reply

In Reply Dr Yu and colleagues highlight the lack of information on surgical approach as a limitation to our study. Surgical approach was not considered to represent a confounder a priori because it is not associated with the exposure (ie, surgical approach does not influence the choice of cemented or uncemented fixation). While the direct anterior approach has recently been associated with worse early outcomes following elective total hip arthroplasty for osteoarthritis, this surgical approach is not routinely used in hemiarthroplasty treatment of femoral neck fractures. In addition, the findings of our multivariable analysis were supported by the instrumental variable analysis, an established method for addressing unmeasured confounders.
Source: JAMA - Category: General Medicine Source Type: research