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Micicoi G, de Geofroy B, Chamoux J, Ghabi A, Gauci MO, Bernard de Dompsure R, Bronsard N, Gonzalez JF. Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach. Orthop Traumatol Surg Res 2024:103911. [PMID: 38801888 DOI: 10.1016/j.otsr.2024.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates. HYPOTHESIS Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach. MATERIAL AND METHODS This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative "hidden" blood loss. The risk of early dislocation (less than 6 months) was also analyzed. RESULTS Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03). CONCLUSION This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk. LEVEL OF PROOF III, comparative study of continuous series.
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Affiliation(s)
- Grégoire Micicoi
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France.
| | - Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Julien Chamoux
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Ammar Ghabi
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Marc-Olivier Gauci
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Régis Bernard de Dompsure
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Nicolas Bronsard
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Jean-François Gonzalez
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
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Peuchot H, Jacquet C, Fabre-Aubrespy M, Ferguson D, Ollivier M, Flecher X, Argenson JN. No benefit of direct anterior over posterolateral approach in total hip arthroplasty using dual-mobility acetabular component for femoral neck fracture. Bone Joint J 2024; 106-B:133-138. [PMID: 38688506 DOI: 10.1302/0301-620x.106b5.bjj-2023-0832.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in femoral neck fractures (FNFs). In osteoarthritis, the direct anterior approach (DAA) has been promoted for improving early functional results compared with the posterolateral approach (PLA). The aim of this study was to compare these two approaches in FNF using DMC-THA. Methods A prospective continuous cohort study was conducted on patients undergoing operation for FNF using DMC by DAA or PLA. Functional outcome was evaluated using the Harris Hip Score (HHS) and Parker score at three months and one year. Perioperative complications were recorded, and radiological component positioning evaluated. Results There were 50 patients in the DAA group and 54 in the PLA group. The mean HHS was 85.5 (SD 8.8) for the DAA group and 81.8 (SD 11.9) for the PLA group (p = 0.064). In all, 35 patients in the DAA group and 40 in the PLA group returned to their pre-fracture Parker score (p = 0.641) in both groups. No statistically significant differences between groups were found at one year regarding these two scores (p = 0.062 and p = 0.723, respectively). The DAA was associated with more intraoperative complications (p = 0.013). There was one dislocation in each group, and four revisions for DAA and one for PLA, but this difference was not statistically significant. There were also no significant differences regarding blood loss, length of stay, or operating time. Conclusion In DMC-THA for FNF, DAA did not achieve better functional results than PLA, either at three months or at one year. Moreover, DAA presented an increased risk of intra-operative complications.
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Affiliation(s)
- Henri Peuchot
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Christophe Jacquet
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - David Ferguson
- Trauma & Orthopaedic Department, Royal London Hospital, London, UK
| | - Matthieu Ollivier
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Xavier Flecher
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
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Charles T, Bloemers N, Kapanci B, Jayankura M. Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures. World J Orthop 2024; 15:22-29. [PMID: 38293256 PMCID: PMC10824065 DOI: 10.5312/wjo.v15.i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/15/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1% to 17%. This serious complication is associated with increased morbidity and mortality rates. Approaches to this surgery are still debated, with no consensus regarding the superiority of any single approach. AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches (PL) for hip hemiarthroplasty after femoral neck fractures. METHODS This is a comparative, retrospective, single-center cohort study conducted at a university hospital. Between March 2008 and December 2018, 273 patients (a total of 280 hips) underwent bipolar hemiarthroplasties (n = 280) for displaced femoral neck fractures using either the PL (n = 171) or the minimally invasive direct anterior approach (DAA) (n = 109). The choice of approach was related to the surgeons' practices; the implant types were similar and unrelated to the approach. Dislocation rates and other complications were reviewed after a minimum follow-up of 6 mo. RESULTS Both treatment groups had similarly aged patients (mean age: 82 years), sex ratios, patient body mass indexes, and patient comorbidities. Surgical data (surgery delay time, operative time, and blood loss volume) did not differ significantly between the groups. The 30 d mortality rate was higher in the PL group (9.9%) than in the DAA group (3.7%), but the difference was not statistically significant (P = 0.052). Among the one-month survivors, a significantly higher rate of dislocation was observed in the PL group (14/154; 9.1%) than in the DAA group (0/105; 0%) (P = 0.002). Of the 14 patients with dislocation, 8 underwent revision surgery for recurrent instability (posterior group), and one of them had 2 additional procedures due to a deep infection. The rate of other complications (e.g., perioperative and early postoperative periprosthetic fractures and infection-related complications) did not differ significantly between the groups. CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate (< 1%) than the PL.
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Affiliation(s)
- Tatiana Charles
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Nicolas Bloemers
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Bilal Kapanci
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Marc Jayankura
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
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Tol MCJM, Willigenburg NW, Rasker AJ, Willems HC, Gosens T, Heetveld MJ, Schotanus MGM, Eggen B, Kormos M, van der Pas SL, van der Vaart AW, Goslings JC, Poolman RW. Posterolateral or Direct Lateral Surgical Approach for Hemiarthroplasty After a Hip Fracture: A Randomized Clinical Trial Alongside a Natural Experiment. JAMA Netw Open 2024; 7:e2350765. [PMID: 38206628 PMCID: PMC10784859 DOI: 10.1001/jamanetworkopen.2023.50765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
Importance Hip fractures in older adults are serious injuries that result in disability, higher rates of illness and death, and a substantial strain on health care resources. High-quality evidence to improve hip fracture care regarding the surgical approach of hemiarthroplasty is lacking. Objective To compare 6-month outcomes of the posterolateral approach (PLA) and direct lateral approach (DLA) for hemiarthroplasty in patients with acute femoral neck fracture. Design, Setting, and Participants This multicenter, randomized clinical trial (RCT) comparing DLA and PLA was performed alongside a natural experiment (NE) at 14 centers in the Netherlands. Patients aged 18 years or older with an acute femoral neck fracture were included, with or without dementia. Secondary surgery of the hip, pathological fractures, or patients with multitrauma were excluded. Recruitment took place between February 2018 and January 2022. Treatment allocation was random or pseudorandom based on geographical location and surgeon preference. Statistical analysis was performed from July 2022 to September 2022. Exposure Hemiarthroplasty using PLA or DLA. Main Outcome and Measures The primary outcome was health-related quality of life 6 months after surgery, quantified with the EuroQol Group 5-Dimension questionnaire (EQ-5D-5L). Secondary outcomes included dislocations, fear of falling and falls, activities of daily living, pain, and reoperations. To improve generalizability, a novel technique was used for data fusion of the RCT and NE. Results A total of 843 patients (542 [64.3%] female; mean [SD] age, 82.2 [7.5] years) participated, with 555 patients in the RCT (283 patients in the DLA group; 272 patients in the PLA group) and 288 patients in the NE (172 patients in the DLA group; 116 patients in the PLA group). In the RCT, mean EQ-5D-5L utility scores at 6 months were 0.50 (95% CI, 0.45-0.55) after DLA and 0.49 (95% CI, 0.44-0.54) after PLA, with 77% completeness. The between-group difference (-0.04 [95% CI, -0.11 to 0.04]) was not statistically significant nor clinically meaningful. Most secondary outcomes were comparable between groups, but PLA was associated with more dislocations than DLA (RCT: 15 of 272 patients [5.5%] in PLA vs 1 of 283 patients [0.4%] in DLA; NE: 6 of 113 patients [5.3%]) in PLA vs 2 of 175 patients [1.1%] in DLA). Data fusion resulted in an effect size of 0.00 (95% CI, -0.04 to 0.05) for the EQ-5D-5L and an odds ratio of 12.31 (95% CI, 2.77 to 54.70) for experiencing a dislocation after PLA. Conclusions and Relevance This combined RCT and NE found that among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, PLA was not associated with a better quality of life than DLA. Rates of dislocation and reoperation were higher after PLA. Randomized and pseudorandomized data yielded similar outcomes, which suggests a strengthening of these findings. Trial Registration ClinicalTrials.gov Identifier: NCT04438226.
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Affiliation(s)
- Maria C. J. M. Tol
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Nienke W. Willigenburg
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Ariena J. Rasker
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Hanna C. Willems
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Taco Gosens
- Department of Orthopedics and Trauma Surgery, ETZ, Tilburg, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Martin J. Heetveld
- Department of Trauma Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Martijn G. M. Schotanus
- Department of Orthopedic Surgery & Traumatology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Bart Eggen
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - Mate Kormos
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - Stéphanie L. van der Pas
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Aad W. van der Vaart
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Rudolf W. Poolman
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
- Department of Orthopedic Surgery, LUMC, Leiden, the Netherlands
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Page BJ, Parsons MS, Lee JHS, Dennison JG, Hammonds KP, Brennan KL, Lee Brennan M, Lee Stahl D. Surgical Approach and Dislocation Risk After Hemiarthroplasty in Geriatric Patients With Femoral Neck Fracture With and Without Cognitive Impairments-Does Cognitive Impairment Influence Dislocation Risk? J Orthop Trauma 2023; 37:450-455. [PMID: 37053111 DOI: 10.1097/bot.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To determine whether there is an association between surgical approach and dislocation risk in patients with cognitive impairment compared with those without cognitive impairment treated with hemiarthroplasty for femoral neck fracture. DESIGN Retrospective study. SETTING Large, multicenter health system. PATIENTS/PARTICIPANTS One thousand four hundred eighty-one patients who underwent hemiarthroplasty for femoral neck fractures. 828 hips met inclusion criteria, 290 (35.0%) were cognitively impaired, and 538 (65.0%) were cognitively intact. INTERVENTION Hemiarthroplasty. MAIN OUTCOME MEASURE Prosthetic hip dislocation. RESULTS The overall dislocation rate was 2.1% (17 of 828), 3.4% (10 of 290) in the cognitively impaired group, and 1.3% (7 of 538) in the cognitively intact group with a median time to dislocation of 20.5 days (range 2-326 days), 24.5 days (range 3-326 days), and 19.0 days (range 2-36 days), respectively. In the entire cohort, there were no dislocations (0 of 58) with the direct anterior approach (DA); 1.1% (6 of 553) and 5.1% (11 of 217) dislocated with the modified Hardinge (MH) and posterior approaches (PA), respectively. In the cognitively impaired group, there were no dislocations with the DA (0 of 19); 1.5% (3 of 202) and 10.1% (7 of 69) dislocated with the MH and PA, respectively. In the cognitively intact group, there were no dislocations (0 of 39) with the DA; 0.85% (3 of 351) and 2.7% (4 of 148) dislocated with the MH and PA, respectively. There were statistically significant associations between surgical approach and dislocation in the entire cohort and the cognitively impaired group when comparing the MH and PA groups. This was not observed in the cognitively intact group. Patients who dislocated had 3.2 times (95% CI 1.2, 8.7) ( P = 0.0226) the hazard of death compared with patients who did not dislocate. Dislocation effectively increased the risk of death by 221% (HR 3.2 95% CI 1.2, 8.7) ( P = 0.0226). CONCLUSIONS In this patient population, the PA has a higher dislocation rate than other approaches and has an especially high rate of dislocation when the patients were cognitively impaired. The authors of this study suggest careful consideration of surgical approach when treating these injuries. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian Joseph Page
- Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service, New York, NY
| | | | - Josh Ho-Sung Lee
- Baylor Scott & White, Department of Orthopaedic Surgery, Temple, TX
| | | | | | | | - Michael Lee Brennan
- Baylor Scott & White, Department of Orthopaedic Surgery, Trauma Section, Temple, TX
| | - Dan Lee Stahl
- Baylor Scott & White, Department of Orthopaedic Surgery, Trauma Section, Temple, TX
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Krassnig R, Prager W, Wildburger R, Hohenberger GM. Direct anterior versus antero-lateral approach in hip joint hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:4141-4148. [PMID: 36394659 DOI: 10.1007/s00402-022-04685-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Femoral neck fractures are common injuries in the elderly and represent a major source of morbidity and mortality. Due to the benefits, bipolar hip hemiarthroplasty (BHH) is a popular method to treat. The purpose of this study is to evaluate the functional and radiographic outcomes for BHH comparing the direct anterior approach (DAA) to the anterolateral approach (ALA) to the hip joint. METHODS We used a prospective, randomized observational study design, where we enrolled 83 patients at a level-I-trauma center presenting with indication for BHH. We followed up the participants at defined intervals over a period of 1 year. The follow-up examinations were carried out at defined time intervals for a period of 1 year. Calculations were performed with Statistical Package for Social Sciences (SPSS) 21.0. RESULTS Concerning postoperative pain sensation, the anterior group had statistically significantly decreased pain levels at one (p = 0.02), seven (p = 0.04) and 14 days (p = 0.02) following the intervention when compared to the ALA sample. The postoperative modified Barthel-Index showed a statistically significant difference on the first postoperative day at the anterior group. CONCLUSION Although we compared two minimally invasive approaches, our results shows a statistically significant difference in pain intensity and mobility for the early postoperative period using the direct anterior approach.
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Affiliation(s)
- Renate Krassnig
- AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, 8144, Tobelbad, Austria.
| | - Walter Prager
- Department of Trauma Surgery, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße18, 8330, Fürstenfeld, Austria
| | - Renate Wildburger
- AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, 8144, Tobelbad, Austria
| | - Gloria M Hohenberger
- Department of Trauma Surgery, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße18, 8330, Fürstenfeld, Austria
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Domingue G, Warren D, Koval KJ, Riehl JT. Complications of Hip Hemiarthroplasty. Orthopedics 2023; 46:e199-e209. [PMID: 36719411 DOI: 10.3928/01477447-20230125-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [Orthopedics. 2023;46(4):e199-e209.].
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Filippini M, Bortoli M, Montanari A, Pace A, Di Prinzio L, Lonardo G, Parisi SC, Persiani V, De Cristofaro R, Sambri A, De Paolis M, Fiore M. Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1220. [PMID: 37512031 PMCID: PMC10385644 DOI: 10.3390/medicina59071220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Background: Femoral neck fractures are an epidemiologically significant issue with major effects on patients and health care systems, as they account for a large percentage of bone injuries in the elderly. Hip hemiarthroplasty is a common surgical procedure in the treatment of displaced femoral neck fractures. Several surgical approaches may be used to access the hip joint in case of femoral neck fractures, each with its own benefits and potential drawbacks, but none of them has consistently been found to be superior to the others. This article aims to systematically review and compare the different approaches in terms of the complication rate at the last follow-up. Methods: an in-depth search on PubMed/Scopus/Web of Science databases and a cross-referencing search was carried out concerning the articles comparing different approaches in hemiarthroplasty and reporting detailed data. Results: A total of 97,576 hips were included: 1030 treated with a direct anterior approach, 4131 with an anterolateral approach, 59,110 with a direct lateral approach, and 33,007 with a posterolateral approach. Comparing the different approaches, significant differences were found in both the overall complication rate and the rate of revision surgery performed (p < 0.05). In particular, the posterolateral approach showed a significantly higher complication rate than the lateral approach (8.4% vs. 3.2%, p < 0.001). Furthermore, the dislocation rate in the posterolateral group was significantly higher than in the other three groups considered (p < 0.026). However, the posterolateral group showed less blood loss than the anterolateral group (p < 0.001), a lower intraoperative fractures rate than the direct anterior group (p < 0.035), and shorter mean operative time than the direct lateral group (p < 0.018). Conclusions: The posterolateral approach showed a higher complication rate than direct lateral approach and a higher prosthetic dislocation rate than the other three types of surgical approaches. On the other hand, patients treated with posterolateral approach showed better outcomes in other parameters considered, such as mean operative time, mean blood loss and intraoperative fractures rate. The knowledge of the limitations of each approach and the most common associated complications can lead to choosing a surgical technique based on the patient's individual risk.
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Affiliation(s)
- Matteo Filippini
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Andrea Montanari
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Andrea Pace
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | | | - Gianluca Lonardo
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Valentina Persiani
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Roberto De Cristofaro
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Sambri
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Innocenti M, Cozzi Lepri A, Civinini A, Mondanelli N, Matassi F, Stimolo D, Cerciello S, Civinini R. Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures. Geriatr Orthop Surg Rehabil 2023; 14:21514593231170844. [PMID: 37162810 PMCID: PMC10164248 DOI: 10.1177/21514593231170844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/03/2023] [Accepted: 03/31/2023] [Indexed: 05/11/2023] Open
Abstract
Introduction Total hip arthroplasty (THA) performed for femoral neck fractures (FNFs) is becoming a more frequent treatment in the active elderly population. Since there is limited research available presenting clinical outcomes after THA using the anterior-based muscle sparing (ABMS) approach, the aim of this study was to compare this surgical approach to the direct lateral (DL) approach in patients treated by THA for FNFs. Materials and Methods We retrospectively reviewed the data prospectively collected as a part of our "Hip Fracture Unit" and included 163 patients who underwent THA from January 2016 to January 2019 for acute displaced FNFs. Results A total of 132 patients who completed a minimum 2-years follow up (69 in the ABMS group and 63 in DL group) were included. The ABMS group demonstrated significantly shorter time to reach milestone for hospital discharge (1.5 Days vs 2.1 days, P = .018), while no statistically significant differences were detected in peri-operative complications. At 3 months, the timed up and go test, the Harris Hip Score (HHS) and the Oxford ip Score (OHS) were significantly better (P = .024, .032 and .034, respectively) in the ABMS group compared to the DL group. No differences were found in functional outcomes (HHS and OHS) nor in complication rate at 6, 12 and 24 months. Discussion This is one of the first studies to analyze functional results of THA performed for FNFs through an ABMS approach. Results are in line with those already present in the Literature. Conclusion ABMS approach allows earlier mobilization and better early functional outcomes, compared to DL approach, in patients undergoing THA for acute displaced FNF. No differences are found after 6 months in functional results and complications rate.
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Affiliation(s)
- Matteo Innocenti
- Department of Health Sciences, Orthopedic Unit, University of Florence, Florence, Italy
| | - Andrea Cozzi Lepri
- Department of Health Sciences, Orthopedic Unit, University of Florence, Florence, Italy
| | - Alessandro Civinini
- Department of Health Sciences, Orthopedic Unit, University of Florence, Florence, Italy
| | - Nicola Mondanelli
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Fabrizio Matassi
- Department of Health Sciences, Orthopedic Unit, University of Florence, Florence, Italy
| | - Davide Stimolo
- Department of Health Sciences, Orthopedic Unit, University of Florence, Florence, Italy
| | | | - Roberto Civinini
- Department of Health Sciences, Orthopedic Unit, University of Florence, Florence, Italy
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Viberg B, Kristensen EQ, Gaarsdal T, Petersen CD, Jensen TG, Overgaard S, Palm H. A piriformis-preserving posterior approach reduces dislocation rate of the hemiarthroplasty in patients with femoral neck fracture. Injury 2023:S0020-1383(23)00382-0. [PMID: 37100693 DOI: 10.1016/j.injury.2023.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The posterior approach (PA) for hemiarthroplasty (HA) in patients with femoral neck fracture (FFN) has a high risk of dislocation; however, by preserving the piriformis muscle, the dislocation rate could be lowered considerably. The aim of this study was to compare the surgical complications of the piriformis-preserving posterior approach (PPPA) and the PA in patients with FNF treated with HA. METHODS On 1 January 2019, the PPPA was introduced at two hospitals as the new treatment standard. The sample size was calculated based on a 5 percentage point dislocation reduction and 25% censoring; a sample of 264 patients per group was determined. An approximately 2-year inclusion period with 1-year follow-up was estimated, including a historical cohort from 2 years before the PPPA introduction. Data were retrieved from health care records and X-ray images from the hospitals' administrative databases. Relative risk (RR) and 95% confidence intervals were calculated using Cox regression and adjusted for age, sex, comorbidity, smoking, surgeon experience and implant type. RESULTS There were 527 patients included in the study, of which 72% were women and 43% were above 85 years old. There were no baseline differences between the PPPA and PA groups in sex, age, comorbidity, body mass index, smoking, alcohol, mobility, length of surgery, blood loss or implant positioning, but there were differences in 30-day mortality, surgeon experience and implant type. The dislocation rate reduced from 11.6% in the PA group to 4.7% in the PPPA group (p = 0.004), with an RR of 2.5 (1.2; 5.1). The reoperation rate reduced from 6.8% with the PA to 3.3% with the PPPA (p = 0.022), with an RR of 2.1 (0.9; 5.2), and total surgery-related complications reduced from 14.7% with the PA to 6.9% with the PPPA (p = 0.003), with an RR of 2.4 (1.3; 4.4). INTERPRETATION Changing from PA to PPPA in patients with FNF treated with HA resulted in a more than 50% reduction in dislocation and reoperation rates. This approach was easily introduced and may enable further lowering of dislocation rates through the sparing of all short external rotators.
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Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital Kolding, University Hospital of Southern Denmark, Denmark.
| | - Erik Qvist Kristensen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital Kolding, University Hospital of Southern Denmark, Denmark
| | - Thomas Gaarsdal
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | | | - Thomas Giver Jensen
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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11
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Apinyankul R, Satravaha Y, Mokmongkolkul K, Phruetthiphat OA. Comparison of Dislocation and Outcome Between Piriformis-Sparing and Conventional Posterior Approach After Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients Over 60 Years. J Arthroplasty 2023; 38:732-736. [PMID: 36273711 DOI: 10.1016/j.arth.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hemiarthroplasty is a treatment option for femoral neck fractures in patients aged more than 60 years and postoperative dislocation after a posterior approach is not uncommon. The piriformis tendon is one of the structures providing posterior hip stability. However, evidence of piriformis-sparing approach in hemiarthroplasty is unclear regarding a reduced dislocation rate. METHODS Between January 2017 and December 2019, 321 patients underwent a posterior approach in consecutive cohorts for a hemiarthroplasty for femoral neck fractures with the minimum 24 months follow-up time (24-60 months). There were two cohorts: (1) 129 underwent the conventional posterior (CP) approach and (2) 192 underwent the piriformis-sparing (PS) approach. The differences in dislocation rate, postoperative Harris Hip Society at 1 and 2 years and other surgical complications were compared in both groups. RESULTS There were 6 dislocations of 129 (4.7%) underwent the CP approach and 0 dislocation from 192 underwent the PS approach that had posterior hip dislocations (P = .004). In addition, the CP group had a significantly higher mortality rate (14.7% versus 7.3%, P = .031) and lower functional outcomes as assessed by mean Harris Hip Scores at 1 year (73 versus 78, P = .005) and 2 years postoperatively (73 versus 80, P < .001) relative to the PS group. CONCLUSION PS hemiarthroplasty was associated with a lower dislocation and mortality rate. Moreover, this approach gained a superior early to the mid-term functional outcome than the conventional posterior approach in elderly femoral neck fractures. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Rit Apinyankul
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yodhathai Satravaha
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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12
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Shuai L, Huiwen W, Shihao D, Fangyuan W, Juehua J, Jun L. A comparison of different surgical approaches to hemiarthroplasty for the femoral neck fractures: A meta-analysis. Front Surg 2023; 9:1049534. [PMID: 36684243 PMCID: PMC9852338 DOI: 10.3389/fsurg.2022.1049534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/02/2022] [Indexed: 01/09/2023] Open
Abstract
There are three traditional surgical approaches to hemiarthroplasty (HA) for femoral neck fractures, respectively, the anterior approach (AA), the lateral approach (LA) and the posterior approach (PA). However, the optimum approach is still controversial, the purpose of this meta-analysis is to identify the merits and demerits of all three approaches. All clinical published studies in PubMed, Web of Science, Embase, and the Cochrane Library from January 2000 to April 2022 were searched which compared different surgical approaches and covered surgery-related outcomes and frequent complications. Five randomized controlled trials and 26 cohort studies for a total of 31 clinical trials were included in the meta-analysis. The dislocation of PA was significantly higher than LA (OR: 3.00 95% CI: 2.25-4.01 I 2 = 27% P < 0.00001) and AA (OR: 6.61 95% CI: 2.28-19.13 I 2 = 0% P = 0.0005); PA was substantially more than LA in terms of risk of postoperative reoperation (P < 0.05); meanwhile, AA has markedly shorter hospital length of stays than LA. The remaining items showed no significant differences in the results.The results of this meta-analysis demonstrated that the risk of PA dislocation and reoperation is higher with hemiarthroplasty, and AA has markedly shorter hospital length of stays than LA.
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Affiliation(s)
- Liang Shuai
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Wu Huiwen
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Deng Shihao
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Wang Fangyuan
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jing Juehua
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,Correspondence: Jing Juehua Li Jun
| | - Li Jun
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,Correspondence: Jing Juehua Li Jun
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13
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Blanco JF, da Casa C, Fidalgo H, García-Iglesias MA, González-García L, Burón-Álvarez I, Sañudo S, García-Alonso M. Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T3-T11. [PMID: 36265783 DOI: 10.1016/j.recot.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS The women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.
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Affiliation(s)
- J F Blanco
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
| | - C da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - H Fidalgo
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - M A García-Iglesias
- Unidad de Documentación Clínica, Hospital Universitario de Salamanca, Salamanca, España
| | - L González-García
- Departamento de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Asistencial de Palencia, Palencia, España
| | - I Burón-Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Asistencial de Palencia, Palencia, España
| | - S Sañudo
- Unidad de Documentación Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | - M García-Alonso
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Río Hortega, Valladolid, España
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14
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Blanco JF, da Casa C, Fidalgo H, García-Iglesias MA, González-Garcia L, Burón-Alvarez I, Sañudo S, García-Alonso M. Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:3-11. [PMID: 35973555 DOI: 10.1016/j.recot.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.
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Affiliation(s)
- J F Blanco
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
| | - C da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - H Fidalgo
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - M A García-Iglesias
- Clinical Documentation Unit, Hospital Universitario de Salamanca, Salamanca, Spain
| | - L González-Garcia
- Orthopaedic Surgery and Traumatology Department, Complejo Hospitalario Asistencial de Palencia, Palencia, Spain
| | - I Burón-Alvarez
- Orthopaedic Surgery and Traumatology Department, Complejo Hospitalario Asistencial de Palencia, Palencia, Spain
| | - S Sañudo
- Clinical Documentation Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M García-Alonso
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Río Hortega, Valladolid, Spain
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15
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Shoji T, Inoue T, Kato Y, Fujiwara Y, Sumii J, Shozen H, Adachi N. The impact of increasing femoral offset and stem anteversion on postoperative dislocation in bipolar hemiarthroplasty. Clin Biomech (Bristol, Avon) 2022; 100:105770. [PMID: 36209568 DOI: 10.1016/j.clinbiomech.2022.105770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoral offset and anteversion have been reported to affect the incidence of dislocation following bipolar hemiarthroplasty, although the magnitudes of contributions of the femoral offset and stem anteversion on dislocation, both singly and in combination is not fully understood. METHODS Using the CT data of 61 patients (61 hips), including 30 male and 31 female who underwent bipolar hemiarthroplasty, three-dimensional dynamic motion analysis was performed using a modular implant that enabled adjustment of femoral offset and stem anteversion independently. The pattern of impingement and relationship between femoral offset/stem anteversion and range of motion were evaluated using the software. FINDINGS We found that a higher femoral offset and stem anteversion correlate with a greater range of motion of flexion and internal rotation. Furthermore, an increased femoral offset has a great effect on increasing range of motion of flexion than stem anteversion, and increased both femoral offset and stem anteversion have fewer effect on the flexion, whereas increasing stem anteversion has a great impact on internal rotation than offset, especially in the case with lower femoral anteversion. However, a higher stem anteversion decrease the range of motion of external rotation, whereas a higher femoral offset leads to an increased range of motion of external rotation. INTERPRETATION We demonstrated that both a higher femoral offset and stem anteversion substantially affected the range of motion in flexion, internal rotation and external rotation. However, these are not independent, but rather mutually confounding, the surgeons should consider retaining femoral/anterior offset in bipolar hemiarthroplasty.
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Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Junnichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Shozen
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Faggiani M, Risitano S, Rissolio L, Baroni C, Alberghina F, Conforti L. Comparison of Anterior and Lateral Approach in Hip Hemiarthroplasty for Femur Neck Fractures in the Elderly: Clinical and Radiographic Outcomes. Malays Orthop J 2022; 16:113-119. [PMID: 36589369 PMCID: PMC9791902 DOI: 10.5704/moj.2211.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/13/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 - dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.
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Affiliation(s)
- M Faggiani
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy,Corresponding Author: Marianna Faggiani, Department of Orthopaedics and Traumatology, ASL TO5, Piazza Silvio Pellico, 1, Chieri, Turin, 10023, Piedmont, Italy
| | - S Risitano
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - L Rissolio
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - C Baroni
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - F Alberghina
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - L Conforti
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
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17
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Nakamura T, Yamakawa T, Hori J, Goto H, Nakagawa A, Takatsu T, Naoki Osamura, Saito A, Keisuke Hagio, Mouri K. Conjoined tendon preserving posterior approach in hemiarthroplasty for femoral neck fractures: A prospective multicenter clinical study of 322 patients. J Orthop Surg (Hong Kong) 2022; 29:23094990211063963. [PMID: 34920684 DOI: 10.1177/23094990211063963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The posterior approach is widely used in femoral hemiarthroplasty. The major problem with this approach is the high risk of postoperative dislocation. A modified posterior approach, the conjoined tendon preserving posterior approach (CPP), was developed to reduce postoperative dislocations. The objective of this multicenter study was to evaluate the efficacy and safety of hemiarthroplasty performed using the CPP approach for femoral neck fractures. METHODS A total of 322 patients with femoral neck fracture, from 10 facilities, were prospectively studied. Bipolar hemiarthroplasty using the CPP approach was performed, using the same type of implants. Hip joint movement was not restricted following surgery, regardless of a patient's cognitive status. Final follow-up was performed 9.1 ± 1.5 months after surgery. RESULTS Hemiarthroplasty was undertaken in 320 patients using the CPP approach. The mean age, operative time, and intraoperative blood loss were 83.3 ± 7.4 years, 70.0 ± 22.7 min, and 134.8 ± 107.9 mL, respectively. No postoperative dislocations were observed during the study period. Intraoperative adverse events related to the hip joint included femoral fractures in five patients (1.6%) and trochanteric fractures in four patients (1.3%). Postoperative hip joint adverse events included a periprosthetic fracture in one patient (0.3%), deep infection in two patients (0.6%), and stem subsidence in one patient (0.3%). Postoperative deaths occurred in 23 patients (7.2%). One patient (0.3%) had a severe non-hip adverse event unrelated to surgery that prevented independent living, while five patients (1.6%) had a moderate non-hip adverse event that required treatment. CONCLUSION The CPP approach prevented postoperative dislocation following femoral hemiarthroplasty in elderly patients, with no CPP-associated specific adverse events.
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Affiliation(s)
- Takuya Nakamura
- Department of Orthopedic Surgery, 37113Toyama Prefectural Central Hospital, Toyama, Toyama
| | - Toru Yamakawa
- Department of Orthopedic Surgery, 37071Japanese Red Cross Ise Hospital, Ise, Mie
| | - Junji Hori
- Department of Orthopedic Surgery, 38350Chugoku Rosai Hospital, Kure, Hiroshima
| | - Hisataka Goto
- Department of Orthopedic Surgery, 38454Nagasaki Rosai Hospital, Sasebo, Nagasaki
| | - Akihiko Nakagawa
- Department of Orthopedic Surgery, 373360Holy Spirit Hospital, Nagoya, Aichi
| | - Tetsuro Takatsu
- Department of Orthopedic Surgery, 37079Gifu Prefectural Tajimi Hospital, Tajimi, Gifu
| | - Naoki Osamura
- Department of Orthopedic Surgery, 38081National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa
| | - Atsushi Saito
- Department of Orthopedic Surgery, 200682Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo
| | - Keisuke Hagio
- Department of Orthopedic Surgery, 38429National Hospital Organization Osaka Minami Medical Center, Kawachinagano City, Osaka
| | - Kanto Mouri
- Department of Orthopedic Surgery, 13771Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo
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Cnudde PHJ, Nåtman J, Hailer NP, Rogmark C. Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease : analysis of 9,638 patients from the Swedish Hip Arthroplasty Register. Bone Joint J 2022; 104-B:134-141. [PMID: 34969279 DOI: 10.1302/0301-620x.104b1.bjj-2021-0855.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. METHODS We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). RESULTS A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. CONCLUSION Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA. Cite this article: Bone Joint J 2022;104-B(1):134-141.
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Affiliation(s)
- Peter H J Cnudde
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden.,Department of Orthopaedics, Hywel Dda University Health Board, Llanelli, UK
| | | | - Nils P Hailer
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Cecilia Rogmark
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Lund University Faculty of Medicine, Malmö, Sweden
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Layson JT, Coon MS, Sharma R, Diedring B, Afsari A, Best B. Comparing Postoperative Leg Length Discrepancy and Femoral Offset Using Two Different Surgical Approaches for Hemiarthroplasty of the Hip. Spartan Med Res J 2021; 6:25096. [PMID: 34532620 PMCID: PMC8405281 DOI: 10.51894/001c.25096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The direct anterior approach (DAA) and anterolateral approach (ALA) may be used for hip hemiarthroplasty (HHA) as a treatment for femoral neck fractures. The DAA often utilizes intraoperative fluoroscopy to determine leg length and offset, while the ALA traditionally utilizes an intraoperative clinical exam to determine offset and leg length. This study will evaluate two techniques: the "grid fluoroscopy [GF] technique" and the "intraoperative exam [IE] technique," each performed by one of two separate surgeons, and compare each technique's accuracy to restore leg length and femoral offset in a patient population that underwent HHA. METHODS Two investigators retrospectively reviewed charts of 208 randomly selected patients who had an HHA from either a DAA or ALA performed by two different surgeons for the treatment of femoral neck fractures. Postoperative AP pelvis radiographs were measured to determine offset and leg length compared with the non-operative extremity. Non-normal continuous variables were provided by median and interquartile range. Data were analyzed with the Mann-Whitney U test and Student's t-test. RESULTS After inclusion and exclusion criteria, data were reviewed on 173 hemiarthroplasties. The mean age was 80.3 years (± 11.2 years). Of the surgical patients, 65.9% were female, and 70.9% identified their ethnicity as white. The DAA was used in 93 patients and ALA in 80 patients. Analysis comparing the two techniques demonstrated no statistically significant differences in median leg length between GF technique (1.02 IQR -0.1, 2.0 mm) and IE technique (1.25 IQR -2.4, 1.3 mm,) (p=0.67). There was also no statistically significant difference in offset between GF technique (1.3 IQR 0.2, 2.1 mm) and IE technique (0.6 IQR -2.7 mm, 3.2 mm) (p=0.13). However, a difference was found in mean length of surgery that was statistically significant. We found that the mean length of surgery for the IE technique was 74.8 ± 24.7 minutes versus the GF technique, which was 95.1 ± 23.0 minutes, (p<0.0001). DISCUSSION There was no significant difference between leg length and offset with the use of intraoperative fluoroscopy with DAA compared to no intraoperative imaging with ALA. Our study suggests that DAA and ALA are equally effective approaches for re-establishing symmetric leg length and offset in HHA for femoral neck fractures. In this study, the ALA had a shorter surgical time compared to DAA, potentially due to the utilization of intraoperative fluoroscopy for this particular technique during the DAA.
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20
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Nogler M, Randelli F, Macheras GA, Thaler M. Hemiarthroplasty of the hip using the direct anterior approach. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:304-317. [PMID: 34342656 PMCID: PMC8360897 DOI: 10.1007/s00064-021-00727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Minimally invasive approach in total hip arthroplasty for the treatment of femoral neck fractures with a hemiarthroplasty. INDICATIONS Femoral neck fractures of patients without hip osteoarthritis where the acetabulum is still intact. CONTRAINDICATIONS Lesions and infections of the skin in the approach area; hip osteoarthritis; surgeon's lack of experience with the technique. SURGICAL TECHNIQUE The direct anterior approach (DAA) uses the Smith-Peterson interval between the tensor fasciae latae (TFL) and the rectus and sartorius muscle. After coagulation of the ascending branches of the femoral circumflex vessels, the capsule is opened. The remaining parts of the femoral neck are removed and osteotomized if necessary. The femoral head is removed with a cork screw. Then the shaft is supported by 2 sharp retractors at the greater trochanter from cranial, and the leg is externally rotated, hyperextended, and adducted. A TFL release can be performed which we also recommend. The femoral canal is opened step by step and extended with rasps which are introduced with the double curved broach handle. Cement and the final implant are introduced and after the trial reduction also the final head. The hip is reduced, the capsule adapted and the wound closed. POSTOPERATIVE MANAGEMENT For this approach, there are no approach specific recommendations. Postoperative treatment depends on whether the approach was extended with muscle releases and on the type of reconstruction performed. If the approach was limited to the minimally invasive direct anterior portal, quicker rehabilitation can be expected due to the reduced muscle damage. We prefer mobilization with full weight bearing as tolerated on the next day.
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Affiliation(s)
- Michael Nogler
- Department of Orthopedic Surgery-Experimental Orthopedics, Medical University Innsbruck, Innrain 36, 6020, Innsbruck, Austria.
| | - Filippo Randelli
- CAD-ASST Gaetano Pini-CTO, Centro Specialistico Ortopedico Traumatologico, P.za A. Ferrari, 1, 20122, Milan, Italy
| | - George A Macheras
- Department of Orthopedics, "KAT" General Hospital of Attica, Athens, Greece
| | - Martin Thaler
- Department of Orthopedic Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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21
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Spina M, Luppi V, Chiappi J, Bagnis F, Balsano M. Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study. Aging Clin Exp Res 2021; 33:1635-1644. [PMID: 32910422 DOI: 10.1007/s40520-020-01696-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs). AIM The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs. MATERIALS AND METHODS Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months. RESULTS Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant. CONCLUSIONS The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Mauro Spina
- Department of Orthopedics and Traumatology A, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia.
| | - Valentina Luppi
- Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
| | - Jacopo Chiappi
- Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
| | - Francesco Bagnis
- Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
| | - Massimo Balsano
- Department of Orthopedics and Traumatology A, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
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22
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Reddy AK, Anderson JM, Gray HM, Fishbeck K, Vassar M. Clinical Trial Registry Use in Orthopaedic Surgery Systematic Reviews. J Bone Joint Surg Am 2021; 103:e41. [PMID: 33983151 DOI: 10.2106/jbjs.20.01743] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Results from systematic reviews and meta-analyses, which have the highest level of evidence (Level I), often drive clinical decision-making and health policy. Often, unpublished trial data are omitted from systematic reviews, raising concerns about the extent of the reliability and validity of results that have been drawn from systematic reviews. We aimed to determine the extent to which systematic review authors include searches of clinical trial registries for unpublished data when conducting systematic reviews in orthopaedic surgery. METHODS Systematic reviews and/or meta-analyses were gathered from the top 5 orthopaedic surgery journals based on the h5-index from Google Scholar Metrics. Systematic reviews that had been published in the Cochrane Database of Systematic Reviews, which requires the inclusion of a clinical trial registry search, served as controls. For the primary outcome, each systematic review from the top 5 orthopaedic journals was screened to determine whether the authors of each study searched for unpublished data in clinical trial registries. We then compared the rate of registry searches with those in the control group. For the secondary analysis, a search of ClinicalTrials.gov was performed for unpublished trial data for 100 randomized systematic reviews. RESULTS All 38 of the Cochrane systematic reviews (100%) included clinical trial registry searches, while the top 5 orthopaedic journals had only 31 of 480 studies (6.5%) that looked at clinical trial registries. The secondary analysis yielded 59 of 100 systematic review articles (59.0%) that could have included unpublished clinical trial data from ≥1 studies to their sample. CONCLUSIONS Systematic reviews that have been published in the top orthopaedic surgery journals seldom included a search for unpublished clinical trial data. CLINICAL RELEVANCE The exclusion of clinical trial registry searches potentially contributes to publication bias within the orthopaedic literature. Moving forward, systematic review authors should include clinical trial registry searches for unpublished clinical trial data to provide the most accurate representation of the available evidence for systematic reviews and meta-analyses.
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Affiliation(s)
- Arjun K Reddy
- Office of Medical Student Research (A.K.R., J.M.A., H.M.G., and M.V.) and Department of Psychiatry and Behavioral Sciences (M.V.), Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - J Michael Anderson
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Harrison M Gray
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Keith Fishbeck
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Matt Vassar
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
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Viberg B, Frøslev T, Overgaard S, Pedersen AB. Mortality and revision risk after femoral neck fracture: comparison of internal fixation for undisplaced fracture with arthroplasty for displaced fracture: a population-based study from Danish National Registries. Acta Orthop 2021; 92:163-169. [PMID: 33228452 PMCID: PMC8158198 DOI: 10.1080/17453674.2020.1850940] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and purpose - Hemiarthroplasty has lower reoperation frequency and better mobilization compared with internal fixation (IF) in patients with undisplaced femoral neck fractures (FNF), which might translate into lower mortality. In this population-based cohort study we compare the risk of mortality and reoperation in undisplaced FNF treated with IF and displaced FNF treated with arthroplasty in patients older than 70 years old. We assume that, per se, there is no difference in mortality risk between patients with a displaced and an undisplaced FNF.Patients and methods - Hip fracture patients were identified in the Danish Multidisciplinary Hip Fracture Registry during 2005-2015. Data on medication, comorbidities, reoperation, and mortality were retrieved from other Danish medical databases. IF and arthroplasty patients were compared with regards to mortality and reoperation up to 5 years postoperatively. We calculated hazard ratios (HR) with 95% confidence intervals (CI) adjusting for relevant confounders.Results - We included 19,260 FNF treated with arthroplasty and 10,337 FNF with IF. There was an increased risk of mortality for arthroplasty within 30 days, HR 1.3 (95% CI 1.3-1.4), compared with IF but not after 1 and 5 years. Arthroplasty patients had adjusted HRs for reoperation of 0.8 (0.8-0.9) within 1 year, 0.8 (0.7-0.9) within 2 years, and 0.8 (0.8-0.9) within 5 years postoperatively compared with IF.Interpretation - Patients treated for a displaced FNF with arthroplasty had a higher risk of 30-day mortality compared with patients who had an undisplaced FNF treated with IF. It has to be considered that there were baseline differences in the groups but there was no difference in mortality risk up to 5 years post-surgery. Concerning reoperation, patients with a displaced FNF treated with arthroplasty had a lower risk of reoperation compared with IF for undisplaced FNF.
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Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital – University Hospital of SouthernDenmark, Kolding; ,Department of Regional Health Research, University of Southern Denmark, Odense; ,Orthopaedics Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense; ,Correspondence:
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital;
| | - Søren Overgaard
- Orthopaedics Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense; ,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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24
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Tol MCJM, van Beers LWAH, Willigenburg NW, Gosens T, Heetveld MJ, Willems HC, Bhandari M, Poolman RW. Posterolateral or direct lateral approach for hemiarthroplasty after femoral neck fractures: a systematic review. Hip Int 2021; 31:154-165. [PMID: 32552010 DOI: 10.1177/1120700020931766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The posterolateral approach (PLA) and direct lateral approach (DLA) are the most commonly used approaches for inserting a hemiarthroplasty in the treatment of femoral neck fractures. A recent review concluded that the routine use of PLA should be questioned, but this conclusion itself can be questioned. The aim of this study is to provide an updated overview and critical appraisal of the available evidence, focussing on outcomes most relevant for patients. METHODS We conducted a comprehensive search of literature in the MEDLINE and EMBASE databases and Cochrane Library. Studies (till June 2018) to identify hip fracture clinical trials/comparative studies comparing alternative surgical approaches (PLA and DLA). We explored sources of heterogeneity and conducted pooled analyses when appropriate. RESULTS 264 potentially eligible studies were identified of which 1 RCT, 3 prospective, 3 registry data and 5 retrospective studies were included. The RCT consisted performance and attrition bias. The mean MINORS score of the prospective/register studies was 17.3 (SD 3.5) and 13.8 (SD 1.9) of the 5 retrospective studies. The GRADE score for all the outcomes was very low. Due to the high and various types of biases across the included studies, we did not pool the data. None of studies assessed the activities of daily living functionality. 6 studies reported significantly more dislocations or reoperations due to dislocation in the PLA group, 6 other studies found no differences. DLA patients were more likely to develop abductor insufficiency leading to limping and more need for walking aids. The PLA patients tended to have better quality of life, less pain and more satisfaction compared to the DLA patients. CONCLUSION Based on low-quality studies, PLA may be associated with more dislocations, but patients had less walking problems and a lower tendency to abductor insufficiency compared with DLA. Further clinical trials with methodology rigor are needed to determine which approach is more effective in terms of outcomes relevant to patients.
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Affiliation(s)
- Maria C J M Tol
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | | | | | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Martin J Heetveld
- Department of Trauma Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Hanna C Willems
- Department of Internal Medicine and Geriatrics, AMC, Amsterdam, The Netherlands
| | - Mohit Bhandari
- Department of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, LUMC, Leiden, The Netherlands
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Kataoka M, Fujita H, Hara H, Harada H, Okutani Y, Murotani Y. Influence of the knot position on the union of the greater trochanter after bipolar hip arthroplasty via the modified Dall approach: a prospective non-randomized study. BMC Musculoskelet Disord 2021; 22:162. [PMID: 33568142 PMCID: PMC7877116 DOI: 10.1186/s12891-021-04005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter. Methods This is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter. Results Regarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group. Conclusions The posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position. Trial registration We had approved IRB at our hospital clinical research review committee. Retrospectively registered.
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Affiliation(s)
- Masanao Kataoka
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Hiroshi Fujita
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Hiroaki Hara
- Department of Rehabilitation, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Hideto Harada
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yuki Okutani
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yoshiki Murotani
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
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Abstract
OBJECTIVES To determine if surgeon subspecialty training affects perioperative outcomes for displaced femoral neck fractures treated with hemiarthroplasty. DESIGN Retrospective comparative study. SETTING One health system with 2 hospitals (Level I and Level III trauma centers). PATIENT AND PARTICIPANTS Patients who were treated with hemiarthroplasty for displaced femoral neck fractures between October 2012 and September 2017. OUTCOME MEASURES Leg length discrepancy, femoral offset, estimated blood loss (EBL), incidence of blood transfusion, time to surgery, operative time, and length of stay. Data were analyzed based on the treating surgeon's subspecialty training [arthroplasty (A), trauma (T), other (O)]. Hierarchical regression was used to compare the groups and control for confounding variables. RESULTS A total of 292 patients who received hemiarthroplasty for displaced femoral neck fractures were included (A = 158; T = 73; O = 61). Surgeon subspecialty had a statistically significant effect on operative time, with arthroplasty surgeons completing the procedure 9.6 minutes faster than trauma surgeons and 17.7 minutes faster than other surgeons (P < 0.01; ΔR = 0.03). Surgeon subspecialty did not significantly affect other outcomes, including leg length discrepancy (P = 0.26), femoral offset (P = 0.37), EBL (P = 0.10), incidence of transfusion (P = 0.67), time to surgery (P = 0.10), or length of stay (P = 0.67). CONCLUSIONS This study demonstrates that arthroplasty-trained surgeons perform hemiarthroplasty slightly faster than other subspecialists, but subspecialty training does not affect other perioperative outcomes, including leg length discrepancy, femoral offset, EBL, transfusion rate, time to surgery, or length of stay. This suggests that hemiarthroplasty can be adequately performed by various subspecialists, and deferring treatment to an arthroplasty surgeon might not have a clinically significant benefit in the perioperative period. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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What Factors Increase Revision Surgery Risk When Treating Displaced Femoral Neck Fractures With Arthroplasty: A Secondary Analysis of the HEALTH Trial. J Orthop Trauma 2020; 34 Suppl 3:S49-S54. [PMID: 33027166 DOI: 10.1097/bot.0000000000001936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES HEALTH was a randomized controlled trial comparing total hip arthroplasty with hemiarthroplasty in low-energy displaced femoral neck fracture patients aged ≥50 years with unplanned revision surgery within 24 months of the initial procedure being the primary outcome. No significant short-term differences between treatment arms were observed. The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after hip fracture. METHODS We analyzed 9 potential factors chosen a priori that could be associated with revision surgery. The factors included age, body mass index, major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. Our statistical analysis was a multivariable Cox regression using reoperation within 24 months of index surgery as the dependent variable. RESULTS Of the 1441 patients included in this analysis, 8.1% (117/1441) experienced reoperation within 24 months. None of the studied factors were found to be predictors of revision surgery (P > 0.05). CONCLUSION Both total and partial hip replacements are successful procedures in low-energy displaced femoral neck fracture patients. We were unable to identify any patient or surgeon-controlled factors that significantly increased the need for revision surgery in our elderly and predominately female patient population. One should not generalize our findings to an active physiologically younger femoral neck fracture population. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial. J Orthop Trauma 2020; 34 Suppl 3:S29-S36. [PMID: 33027163 DOI: 10.1097/bot.0000000000001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). CONCLUSION Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. LEVEL OF EVIDENCE Prognostic Level II.
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Factors associated with prolonged wound drainage after hemiarthroplasty for hip fractures in elderly. INTERNATIONAL ORTHOPAEDICS 2020; 44:1823-1831. [PMID: 32728927 DOI: 10.1007/s00264-020-04738-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to determine the incidence of prolonged wound drainage (PWD) and the amount of drainage fluid after hip hemiarthroplasty (HA) and to investigate the risk factors for the development of PWD associated with the patient, fracture and surgical treatment. METHODS Data from 313 patients who underwent HA were prospectively analysed. The mean drainage time and drainage amount of patients with PWD were calculated. Patient demographic data, pre-operative ASA scores and anticoagulation status, presence of diabetes, fracture type, surgical approach, femoral stem type, cable usage, amount of drain output, blood transfusion quantity, time from injury to surgery, time from surgery to discharge and patient blood tests were investigated. RESULTS The incidence of PWD after HA was 8.9% (28 patients). The mean drainage time in patients with PWD was 4.9 ± 1.85 (3-9) days, and the mean collected total fluid volume was 51.1 ± 26.9 (21-132) mL. PWD was more commonly observed in the lateral approach group (p < 0.001) and morbidly obese patients (p < 0.001). In the PWD group, the mean post-operative first-day haemoglobin value was lower (p < 0.001), more blood transfusions were required (p < 0.001) and the amount of drainage output from the closed suction drain (CSD) was higher (p < 0.001). The duration of hospitalization was longer in patients with PWD (p < 0.001). Lateral approach, morbid obesity and increased drainage output were found to be associated with PWD in logistic regression analysis. CONCLUSION Lateral approach, morbid obesity and increased drainage output were found to be risk factors for the occurrence of PWD.
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Kenanidis E, Zagalioti SCC, Milonakis N, Tsapakis EM, Tsiridis E. A Catastrophic Cascade of Postoperative Complications Following Hemiarthroplasty for Femoral Neck Fracture in a Middle-Aged Patient With Schizophrenia. Cureus 2020; 12:e9044. [PMID: 32782863 PMCID: PMC7410513 DOI: 10.7759/cureus.9044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The treatment of a patient with schizophrenia suffering a subcapital hip fracture may be challenging, mainly due to the high risk of postoperative medical and surgical complications. Mechanical complications from the implant are also frequently encountered following hip arthroplasty in patients with schizophrenia. We report the case of a 57-year-old male patient with schizophrenia who underwent hip hemiarthroplasty for a displaced femoral neck fracture. During the initial postoperative period, the patient developed a cascade of surgical and mechanical complications, leading to multiple revision procedures and a suboptimal outcome. The ideal type of treatment of patients with schizophrenia with subcapital hip fracture is still missing. It is, therefore, important to highlight the high risk of postoperative complications in patients with schizophrenia who present with subcapital fractures subsequently treated with hemiarthroplasty.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| | | | - Nikolaos Milonakis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC
| | - Evangelia M Tsapakis
- 1st Academic Department of Psychiatry, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Psychiatry, Agios Charalambos Mental Health Clinic, Heraklion, GRC
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
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Kierszbaum E, Biau D, Moslemi A, Descamps J, Anract P, Hardy A. Anterior approach without traction table: A means of saving time and money in hemiarthroplasty for femoral neck fracture? A case-matched study with and without traction table. Orthop Traumatol Surg Res 2020; 106:583-588. [PMID: 32253137 DOI: 10.1016/j.otsr.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/30/2019] [Accepted: 01/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The costs incurred by management of displaced femoral neck fracture are a public health issue. The anterior approach can be used for partial hip replacement, but costs in terms of equipment and time incurred by using a traction table have not to our knowledge been estimated in this indication. We therefore performed a case-control study, comparing (1) installation and deinstallation times (IT, DT) in partial hip replacement using a standard versus a traction table (ST, TT), and (2) operating times, limb-length radiography and intraoperative complications. HYPOTHESIS Performing the anterior approach on a standard table saves installation and deinstallation time and operating time, without leading to more intraoperative complications. MATERIALS AND METHODS A comparative retrospective study included 102 patients (mean age, 84.8±8 years; 46 ST, 56 TT). Installation time (IT) was calculated between entry in the operating room and performance of the incision; operating time (OT) between incision and closure; and deinstallation time (DT) between closure and leaving the operating room. RESULTS Mean IT in ST (25.5±6.2min) was significantly shorter than in TT (33.9±6.2min) (p=1.1*10-9), as were DT (13±4.7 versus 17±3.4min) (p=4.1*10-6) and OT (73.5±15.9 versus 82.6±21.3minutes) (p=0.01). There were 4 intraoperative complications: 1 greater trochanter fracture in ST and 2 greater trochanter fractures and 1 proximal femoral fracture in TT. Limb-length discrepancy was comparable between ST (3.7±3.2mm (range, 0-15mm)) and TT (5.3±4.6mm (range, 0-20mm)) (p=0.06). DISCUSSION Patient installation on a standard table reduced installation, deinstallation and operating time compared to use of a traction table, without increasing the complications rate. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Elliott Kierszbaum
- Service de Chirurgie Orthopédique et Traumatologique, CHU Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
| | - David Biau
- Service de Chirurgie Orthopédique et Traumatologique, CHU Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Aymane Moslemi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Jules Descamps
- Service de Chirurgie Orthopédique et Traumatologique, CHU Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique et Traumatologique, CHU Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alexandre Hardy
- Service de Chirurgie Orthopédique et Traumatologique, CHU Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Affiliation(s)
- Niloofar Dehghan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.,Banner University Medical Center-Phoenix, Phoenix, Arizona.,The CORE Institute, Phoenix, Arizona
| | - Michael D McKee
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.,Banner University Medical Center-Phoenix, Phoenix, Arizona
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Kamo K, Kido H, Kido S. Comparison of the Incidence of Intra-operative Fractures in Hip Hemi-arthroplasty Performed in Supine and Lateral Positions. Hip Pelvis 2019; 31:33-39. [PMID: 30899713 PMCID: PMC6414404 DOI: 10.5371/hp.2019.31.1.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose The difficulty of femoral preparation with supine-position hip hemi-arthroplasty (HA) often leads to intra-operative fractures (IOFs). We aimed to clarify the incidence and types of IOFs in HA for hip fractures performed in the supine and lateral positions. Materials and Methods We retrospectively investigated cases of HA for acute femoral neck fractures from June 2013 to May 2018. We examined the incidence and types of IOFs according to different approaches. We defined supine-position in HA as the supine and hip-hyperextended (over-range) femoral preparation position, and lateral position as the lateral and hip-flexed femoral preparation position. We used a short tapered wedged stem. Results Supine-position HA was used in 46 patients (23.7%) and lateral-position HA in 148 patients (76.3%). IOFs in supine-position HA occurred in 8 patients (17.4%) and included five Vancouver AGT and three Vancouver B2 fractures. IOFs in lateral-position HA occurred in 3 patients (2.0%) and included one Vancouver AGT and two Vancouver B fractures. Supine-position HA was a risk factor for IOFs (adjusted odds ratio, 9.71; 95% confidence interval, 2.37-39.8; P<0.01). Conclusion Supine-position in HA is an IOF risk factor and significantly increases the incidence of great trochanter fractures of Vancouver type A.
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Affiliation(s)
- Kenta Kamo
- Department of Orthopedic Surgery, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Hidehiko Kido
- Department of Orthopedic Surgery, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Satoshi Kido
- Department of Orthopedic Surgery, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
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Robertson GAJ, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence? World J Orthop 2018; 9:235-244. [PMID: 30479970 PMCID: PMC6242732 DOI: 10.5312/wjo.v9.i11.235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/07/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
This editorial reviews and summarises the current evidence (meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach, two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component, three recent meta-analyses and one Cochrane review have found that while unipolar hemi-arthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up (up to 1 year), there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome, complication profile, functional outcome and acetabular erosion rates at longer-term follow-up (2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis, unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique, three recent meta-analyses and one Cochrane Review have found that, while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties, cemented prostheses have lower rates of implant-related complications (particularly peri-prosthetic femoral fracture) and improved post-operative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality, cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure, one recent meta-analysis has found that, while staples can result in a quicker closure time, there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore, either suture or staple wound closure techniques appear equally appropriate for hip hemi-arthroplasty procedures.
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Affiliation(s)
- Greg AJ Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, United Kingdom
| | - Alexander M Wood
- Orthopaedic Department, Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
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