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Wu N, Ma J, Xiong X, Luo X, Ma X, Yang X, Wang W, Wang Y, Wang Z, Ma F. The influence of direct anterior approach and postero-lateral approach on wound complications after total hip arthroplasty: A meta-analysis. Int Wound J 2024; 21:e14395. [PMID: 37699722 PMCID: PMC10784622 DOI: 10.1111/iwj.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
To date, we have reviewed the synthesis literature critically through four databases: PubMed, Embase, Cochrane Library and Web of Science. Eight relevant studies were examined after compliance with the criteria for inclusion and exclusion, as well as documentation quality evaluation. This report covered all randomised, controlled studies of total hip arthroplasty (THA) comparing the direct anterior approach (DAA) with the postero-lateral approach (PLA). The main result was surgical site infection rate. The secondary results were duration of the operation, length of the incision and VAS score after surgery. The results of the meta-analyses of wound infections in the present trial did not show any statistically significant difference in DAA versus PLA (between DAA and PLA) (OR = 1.42, 95%CI: 0.5 to 4.04, p = 0.51). Compared with PLA, DAA had shorter surgical incision (WMD = -3.2, 95%CI: -4.00 to -2.41; p < 0.001) and longer operative times(WMD = 14. 67, 95%CI: 9.24 to 20.09; p < 0.001). Postoperative VAS scores were markedly lower in DAA compared with PLA within 6 weeks of surgery (p < 0.05), with low heterogeneities(I2 = 0). We found that DAA did not differ significantly from PLA in terms of the risk of wound infection for THA and that the surgical incisions was shorter and less postoperative pain after surgery, even though DAA surgery takes longer.
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Affiliation(s)
- Ning Wu
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The Third Clinical Medical CollegeNingxia Medical UniversityYinchuanChina
| | - Jingzu Ma
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
| | - Xianghua Xiong
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The Third Clinical Medical CollegeNingxia Medical UniversityYinchuanChina
| | - Xiaohai Luo
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
| | - Xiaolin Ma
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The Third Clinical Medical CollegeNingxia Medical UniversityYinchuanChina
| | - Xiao Yang
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The Third Clinical Medical CollegeNingxia Medical UniversityYinchuanChina
| | - Wei Wang
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The Third Clinical Medical CollegeNingxia Medical UniversityYinchuanChina
| | - Yuhai Wang
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
| | - Zhaofu Wang
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The First Clinical Medical CollegeLanzhou UniversityLanzhouChina
| | - Feng Ma
- Orthopedic CenterPeople's Hospital of Ningxia Hui Autonomous RegionYinchuanChina
- The Third Clinical Medical CollegeNingxia Medical UniversityYinchuanChina
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Manzo MA, Hali K, Koucheki R, Wolfstadt JI, Edwards TC, Lex JR. Complications and early recovery following hip hemiarthroplasty through the direct anterior approach: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3267-3286. [PMID: 37256391 DOI: 10.1007/s00590-023-03603-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Minimizing complications is an important focus in hip hemiarthroplasty (HHA) for femoral neck fracture (FNF) patients given the associated high morbidity and mortality rates. This systematic review and meta-analysis aimed to compare the clinical and functional outcomes associated with the direct anterior approach (DAA) compared to other surgical approaches used for HHA. METHODS Studies evaluating HHA-treated FNFs using the DAA were compared through meta-analysis to all other surgical approaches combined and as distinct subgroups. Outcomes included overall complication rate, mortality rate, dislocation rate, reoperation rate, periprosthetic fracture rate, infection rate, length of stay (LOS), mobility, perioperative blood loss, operative time, and postoperative pain. RESULTS Nineteen studies met the inclusion criteria, totaling 2,018 HHAs. DAA significantly reduced the overall complication rate (odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.57 to 0.94, p = 0.01), dislocation rate (OR = 0.34, 95% CI 0.15 to 0.77, p = 0.01), and LOS (mean difference (MD) = -1.31 days, 95% CI - 2.12 to - 0.50, p = 0.002). Findings from studies that were not appropriate for meta-analysis were qualitatively summarized and suggested improved mobility and reduced postoperative pain with the DAA. Significant differences were not detected in any of the remaining outcomes. CONCLUSION The DAA HHA appears to be safer, reduces hospital stay, and may improve early functional recovery. This article supports the DAA HHA as a safe option for the management of displaced intracapsular FNFs.
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Affiliation(s)
- Marc A Manzo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Kalter Hali
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jesse I Wolfstadt
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Granovsky Gluskin Division of Orthopaedics, Sinai Health, Toronto, ON, Canada
| | | | - Johnathan R Lex
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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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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Muacevic A, Adler JR, Koç SS, Bingöl O, Kılıç E, Ozdemir G, Toğral G. Do Different Approaches Make a Difference in Isokinetic Performance in Elderly Patients With Femoral Neck Fracture Who Underwent Bipolar Endoprosthesis? Cureus 2023; 15:e33362. [PMID: 36751156 PMCID: PMC9897598 DOI: 10.7759/cureus.33362] [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] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Background There are ongoing doubts about the effects of the commonly used anterolateral approach (ALA) and posterolateral approach (PLA) for bipolar hemiarthroplasty (BHA) on hip muscle strength after surgery. In this study, it was aimed to evaluate the isokinetic performance of the operated and non-operated hips in patients with femoral neck fractures who underwent BHA with PLA or ALA and to compare the isokinetic performance of the hips and functional results between the two approaches. Materials and methods Forty-one patients who underwent unilateral BHA with PLA or ALA for femoral neck fracture between February 2019 and December 2020 were enrolled. The isokinetic performance of the flexor, extensor, and abductor muscles of the operated and non-operated hips were evaluated by measuring peak torque, total work, and average power. Functional status was assessed using Harris Hip Score and Short Form 36. Results The patients were divided into two groups; those operated with PLA (n=22) and with ALA (n=19). The groups had similar demographic and clinical characteristics. All isokinetic parameters of the operated hips did not differ between the groups (all p>0.05). In both groups, all isokinetic parameters were significantly lower in the operated hips than in the non-operated hips. Conclusion Although there are debates about potential extensor muscle injury with PLA and potential abductor muscle injury with ALA, this study showed that functional results and the isokinetic performance of both approaches were not different.
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Ball S, McAndrew A, Aylward A, Cockcroft E, Gordon E, Kerridge A, Morgan-Trimmer S, Powell R, Price A, Rhodes S, Timperley AJ, van Horik J, Wickins R, Charity J. Detailed statistical analysis plan for a randomised controlled trial of the effects of a modified muscle sparing posterior technique (SPAIRE) in hip hemiarthroplasty for displaced intracapsular fractures on post-operative function compared to a standard lateral approach: HemiSPAIRE. Trials 2022; 23:924. [PMCID: PMC9636782 DOI: 10.1186/s13063-022-06790-z] [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: 08/14/2022] [Accepted: 09/24/2022] [Indexed: 11/08/2022] Open
Abstract
Background The HemiSPAIRE trial is being conducted to determine whether a modified muscle sparing technique (SPAIRE-“Save Piriformis and Internus, Repairing Externus”) in hip hemiarthroplasty brings clinical benefits compared to the standard lateral technique in adults aged 60 years or older, with a displaced intracapsular hip fracture. This article describes the detailed statistical analysis plan for the trial. Methods and design HemiSPAIRE is a definitive, pragmatic, superiority, multicentre, randomised controlled trial (with internal pilot) with two parallel groups. Participants, ward staff and all research staff involved in post-operative assessments are blinded to allocation. This article describes in detail (1) the primary and secondary outcomes; (2) the statistical analysis principles, including a survivor average causal effect (SACE) method chosen specifically to address the issue of potential bias from differential survival between trial arms, which was seen from data review by the Trial Steering Committee, the participants that will be included in each analysis, the covariates that will be included in each analysis, and how the results will be presented; (3) planned main analysis of the primary outcome; (4) planned analyses of the secondary outcomes; and (5) planned additional analyses of the primary and secondary outcomes. Trial registration ClinicalTrials.gov NCT04095611. Registered on 19 September 2019.
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Affiliation(s)
- Susan Ball
- grid.8391.30000 0004 1936 8024Applied Research Collaboration South West Peninsula (PenARC), National Institute for Health and Care Research (NIHR), University of Exeter, Exeter, UK
| | - Amy McAndrew
- grid.8391.30000 0004 1936 8024Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Alex Aylward
- grid.8391.30000 0004 1936 8024Applied Research Collaboration South West Peninsula (PenARC) Patient Engagement Group, National Institute for Health and Care Research (NIHR), University of Exeter, Exeter, UK
| | - Emma Cockcroft
- grid.8391.30000 0004 1936 8024Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth Gordon
- Research and Development Department, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Alison Kerridge
- Research and Development Department, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Sarah Morgan-Trimmer
- grid.8391.30000 0004 1936 8024Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Roy Powell
- Research Design Service – South West, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anna Price
- grid.8391.30000 0004 1936 8024Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Shelley Rhodes
- grid.8391.30000 0004 1936 8024Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Andrew J. Timperley
- Exeter Hip Unit, Royal Devon University Healthcare NHS Foundation Trust, Princess Elizabeth Orthopaedic Centre, Exeter, UK
| | - Jayden van Horik
- grid.8391.30000 0004 1936 8024Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Robert Wickins
- Physiotherapy, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - John Charity
- Exeter Hip Unit, Royal Devon University Healthcare NHS Foundation Trust, Princess Elizabeth Orthopaedic Centre, Exeter, UK
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Price A, Ball S, Rhodes S, Wickins R, Gordon E, Aylward A, Cockcroft E, Morgan-Trimmer S, Powell R, Timperley J, Charity J. Effects of a modified muscle sparing posterior technique in hip hemiarthroplasty for displaced intracapsular fractures on postoperative function compared to a standard lateral approach (HemiSPAIRE): protocol for a randomised controlled trial. BMJ Open 2021; 11:e045652. [PMID: 34103316 PMCID: PMC8190059 DOI: 10.1136/bmjopen-2020-045652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Currently National Institute for Health and Care Excellence clinical guidelines in the UK suggest that surgeons performing partial hip replacements (hemiarthroplasty) should consider using the lateral approach. Alternatively, a newer, modified posterior approach using a muscle sparing technique named 'Save Piriformis and Internus, Repairing Externus' (SPAIRE) can be used leaving the major muscles intact. This randomised controlled trial (RCT) aims to compare the SPAIRE approach to the standard lateral approach, to determine if it allows patients to mobilise better and experience improved function after surgery. METHODS AND ANALYSIS HemiSPAIRE is a two-arm, assessor-blinded, definitive pragmatic RCT with nested pilot and qualitative studies. Two hundred and twenty-eight participants with displaced intracapsular fractures requiring hip hemiarthroplasty will be individually randomised 1:1 to either the SPAIRE, or control (standard lateral approach) surgical procedure. Outcomes will be assessed at postoperative day 3 (POD3) and 120 (POD120). The primary outcome measure will be level of function and mobility using the Oxford Hip Score at POD120. Secondary outcomes include: De Morton Mobility Index (DEMMI), Cumulated Ambulatory Score and Numeric Pain Rating Scale (NPRS) at POD3; DEMMI, NPRS and EQ-5D-5L at POD120, complications, acute and total length of hospital stay, and mortality. Primary analysis will be on an intention-to-treat basis. Participant experiences of the impact of surgery and recovery period will be examined via up to 20 semi-structured telephone interviews. ETHICS AND DISSEMINATION The protocol has been approved by Yorkshire and the Humber-Bradford Leeds Research Ethics Committee. Recruitment commenced in November 2019. Findings will be disseminated via research articles in peer-reviewed journals, presentations at conferences, public involvement events, patient groups and media releases. A summary of the trial findings will be shared with participants at the end of the study. TRIAL REGISTRATION NUMBER NCT04095611.
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Affiliation(s)
- Anna Price
- Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Susan Ball
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, Exeter, UK
| | - Shelley Rhodes
- Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Robert Wickins
- Physiotherapy, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Elizabeth Gordon
- Research, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Alex Aylward
- NIHR Applied Research Collaboration South West Peninsula (PenARC) patient engagement group, University of Exeter Medical School, Exeter, UK
| | - Emma Cockcroft
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, Exeter, UK
| | - Sarah Morgan-Trimmer
- Psychology Applied to Health (PAtH) Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Roy Powell
- Research Design Service, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - John Charity
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Predictors of Medical Serious Adverse Events in Hip Fracture Patients Treated With Arthroplasty. J Orthop Trauma 2020; 34 Suppl 3:S42-S48. [PMID: 33027165 DOI: 10.1097/bot.0000000000001935] [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
AIM Patients with hip fractures are often frail with multiple comorbidities and at risk of medical serious adverse events (SAEs). We investigated the HEALTH trial patient population to ascertain predictors of SAEs. METHODS We performed a multivariable Cox regression analysis. Occurrence of SAEs was included as the dependent variable with 31 potential prognostic factors being included as independent variables. RESULTS One thousand four hundred forty-one patients were included in this analysis. Three hundred seventy (25.6%) patients suffered from an SAE. The most common events were cardiac (38.4%, n = 105), respiratory (20.8%, n = 77), and neurological (14.1%, n = 77). The majority of SAEs (50.8%, n = 188) occurred in the first 90 days after hip fracture with 35.4% occurring in the first 30 days (n = 131). Body mass index (BMI) between 18.5 and 24.9 compared with BMI between 25 and 29.9 [hazard ratio (HR) 1.32, P = 0.03] and receiving a total hip arthroplasty compared with a bipolar hemiarthroplasty (HR 1.36, P = 0.03) were associated with a higher risk of a medical SAE within 24 months of femoral neck fracture. Age (P = 0.09), use of femoral cement (P = 0.59), and use of canal pressurization (P = 0.37) were not associated with a medical SAE. CONCLUSION Total hip arthroplasty is associated with more SAEs in the immediate postoperative period, and care should be taken in selecting patients for this treatment compared with a hemiarthroplasty. A higher BMI may be protective in hip fracture patients while age alone does not predict SAEs and neither does the use of femoral cement and/or pressurization. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Graulich T, Graeff P, Jaiman A, Nicolaides S, Omar Pacha T, Örgel M, Macke C, Omar M, Krettek C, Liodakis E. Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case-control study of patients with CT data. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:627-633. [PMID: 33098004 PMCID: PMC8053145 DOI: 10.1007/s00590-020-02819-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/15/2020] [Indexed: 01/07/2023]
Abstract
Purpose Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty
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Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Graeff
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ashish Jaiman
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Stine Nicolaides
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tarek Omar Pacha
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Peng L, Zeng Y, Wu Y, Zeng J, Liu Y, Shen B. Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:338. [PMID: 32487060 PMCID: PMC7265223 DOI: 10.1186/s12891-020-03318-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes. METHODS We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials. RESULTS A total of 7 randomized controlled trials with 600 participants met the inclusion criteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2 = 93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD = -0.65, 95% CI - 0.91 to - 0.38, p < 0.00001, I2 = 0%), VAS score at 2 days postoperatively (MD = -0.67, 95% CI - 1.34 to - 0.01, p = 0.05, I2 = 88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD = 6.05, 95% CI 1.14 to 10.95, p = 0.02, I2 = 52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected. CONCLUSIONS The DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.
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Affiliation(s)
- Linbo Peng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Yi Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Yuangang Wu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Junfeng Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Yuan Liu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Bin Shen
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China.
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Wu XD, Li Y, Liu JC, Huang W, Qiu GX. Never too old for hip arthroplasty: a 111-year-old woman walks out of hospital-a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:253. [PMID: 32309400 PMCID: PMC7154456 DOI: 10.21037/atm.2020.01.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Centenarians population is proliferating, and hip fractures are responsible for more than 10% of all hospital admissions for centenarian patients, which represents a considerable challenge to patients and healthcare providers. Herein, we first report a case of a 111-year-old woman who suffered from a hip fracture and was successfully managed with cemented hemiarthroplasty surgery. In addition, we further reviewed case reports, news, and related studies to address the central points in managing hip fractures in the centenarian population.
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Affiliation(s)
- Xiang-Dong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ying Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jia-Cheng Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Gui-Xing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
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Kizkapan TB, Misir A, Uzun E, Oguzkaya S, Ozcamdalli M. Factors affecting dislocation after bipolar hemiarthroplasty in patients with femoral neck fracture. Injury 2020; 51:663-669. [PMID: 31987605 DOI: 10.1016/j.injury.2020.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to investigate the anatomic risk factors associated with dislocation following bipolar hemiarthroplasty for the treatment of femoral neck fracture. MATERIALS AND METHODS We retrospectively reviewed 208 consecutive patients (133 women, 75 men) with femoral neck fractures who were treated with bipolar hemiarthroplasty between 2015 and 2018. A comparative analysis was performed between dislocation (n = 18) and non-dislocation (n = 190) groups in terms of patient demographics, surgical and pelvic morphologic factors, and clinical outcomes, including postoperative Harris and modified Harris hip scores. Independent risk factors affecting dislocation were also evaluated. RESULTS The mean follow-up period was 30.8 ± 2.0 (range, 12-48) months. The mean age was 79.2 ± 7.4 (range, 71-94) years. The dislocation rate was 8.6% (18/208), and the mean dislocation time after operation was 2.0 ± 1.1 (range, 1-4) months. Patient-related factors did not differ between the dislocated and non-dislocated groups. As regards dislocation, statistically significant difference was observed in surgical and pelvic morphologic factors, including femoral offset, residual femoral neck length, trochanter upper end and femoral head center distance, and height of the hip center of the operated side (p = 0.025, p = 0.013, p = 0.002, p = 0.008, respectively). Moreover, the femoral offset, height of the hip center, and femoral neck-shaft angle of the non-operated side are significantly different between the groups (p = 0.007, p = 0.001, p = 0.027, respectively). Decrease in the center edge (CE) angle, offset of prosthesis, and increase in femoral head extrusion index (FHEI) of the operated side and decrease in the height of the hip center of the non-operated side increased the risk of dislocation (p = 0.030, OR: 1,306; p = 0.041, OR: 8.15; p = 0.020, OR: 1.038; p = 0.010, OR: 2.02, respectively). CONCLUSIONS Pelvic morphologic features and surgical factors were found to affect dislocation. Patients with smaller OP, CE angle of the operated side, and higher FHEI and smaller height of the hip center of the non-operated side should be carefully monitored to decrease postoperative dislocation.
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Affiliation(s)
- Turan Bilge Kizkapan
- Department of Orthopedics and Traumtology, Bursa Cekirge State Hospital, Bursa, Turkey.
| | - Abdulhamit Misir
- Department of Orthopedics and Traumatology, Health Sciences University Gaziosmanpasa Training and Research Hospital, Karayollari Mah. Osmanbey Cad. 621. Sk Gaziosmanpasa, 34255 Istanbul, Turkey.
| | - Erdal Uzun
- Department of Orthopedics and Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - Sinan Oguzkaya
- Department of Orthopedics and Traumtology, Sivas Sarkisla State Hospital, Sivas, Turkey.
| | - Mustafa Ozcamdalli
- Faculty of Medicine, Department of Orthopedics and Traumatology, Ahi Evran University, Kirsehir, Turkey.
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