Early surgery for periprosthetic hip fracture showed no clear mortality advantage once immortal time was handled

The edition in brief

A Japanese administrative database analysis, emulating a trial in 4,564 patients with periprosthetic hip fracture, compared surgery within two days with surgery at three to ten days. After handling immortal time bias, 90-day mortality was 2.35% against 2.31% (risk ratio 1.01, 95% CI 0.59 to 1.68), and the 30-day estimate was imprecise. The authors do not support assuming the native hip fracture 48-hour standard applies to these fractures for mortality alone, and note other outcomes were not assessed. A meta-analysis of 60 studies and over 1.25 million people found no effect of GLP-1 receptor agonists on bone density, fractures or osteoarthritis scores, but lower lean body mass, with low certainty. A retrospective cohort of 123 patients suggested better biceps strength and function with isotension tenodesis than low-tension fixation. A meta-analysis of 52 studies found better component alignment with robotic knee replacement and only modest short-term gains.