Revisiting the FAITH Trial: A Secondary Analysis Yielding Novel Insights with the Win Ratio

作者：Sofia Bzovsky, Nathan N. O’Hara, Gerard P. Slobogean, Sheila Sprague, Daniel Axelrod, Graeme Hoit, Kiara Pannozzo, Mohit Bhandari, M.F. Swiontkowski, Emil H. Schemitsch, Rudolf W. Poolman, the FAITH Investigators · 发表于：JBJS Open Access · 年份：2025 · DOI：10.2106/jbjs.oa.25.00230 · 研究领域：Meta-analysis and systematic reviews、Health Systems, Economic Evaluations, Quality of Life、Total Knee Arthroplasty Outcomes

Background: Many orthopaedic trials use any unplanned reoperation as the primary outcome, but this overlooks how patients experience those outcomes. Using a high-quality hip fracture trial, we demonstrate how the relative importance of multiple patient-important outcomes can be effectively incorporated into data analysis, providing a more comprehensive understanding of treatment impact. Methods: This secondary analysis of the Fixation using Alternative Implants for the Treatment of Hip Fracture (FAITH) trial included 1,079 patients aged 50 years or older with a low-energy femoral neck fracture who were randomly assigned to treatment with a sliding hip screw or cancellous screws. The original trial used unplanned revision surgery as the primary outcome. Our primary analysis instead used a composite outcome of all-cause mortality at 4 months, ambulation status at 10 weeks (measured by the EuroQol-5 Dimension [EQ-5D] mobility dimension), and days at home within 4 months. We assessed outcomes hierarchically using the win ratio method, comparing each patient with every other patient in the alternative treatment group in a pairwise manner. We conducted sensitivity analyses at 6 and 12 months, and subgroup analyses to explore smoking status and fracture displacement as potential effect modifiers. Results: Of the 1,079 participants, 741 had EQ-5D data available for the primary analysis at 4 months, yielding 137,114 pairwise comparisons. A sliding hip screw was superior to cancellous ...