Posterolateral or direct lateral approach for hemiarthroplasty after femoral neck fractures: a systematic review

2020 ◽  
pp. 112070002093176
Author(s):  
Maria C J M Tol ◽  
Loes W A H van Beers ◽  
Nienke W Willigenburg ◽  
Taco Gosens ◽  
Martin J Heetveld ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Femoral Neck ◽  
Retrospective Studies ◽  
Lateral Approach ◽  
Femoral Neck Fractures ◽  
Posterolateral Approach ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Walking Aids ◽  
Direct Lateral Approach

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.

scholarly journals High risk of positive Trendelenburg test after using the direct lateral approach to the hip compared with the anterolateral approach

2019 ◽  
Vol 101-B (7) ◽  
pp. 793-799 ◽  
Author(s):  
T. O. Ugland ◽  
G. Haugeberg ◽  
S. Svenningsen ◽  
S. H. Ugland ◽  
Ø. H. Berg ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Functional Outcome ◽  
Femoral Neck Fracture ◽  
Outcome Measures ◽  
Lateral Approach ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Patient Reported ◽  
Neck Fracture ◽  
Direct Lateral Approach

Aims The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a femoral neck fracture treated with a hemiarthroplasty. Patients and Methods A total of 150 patients who were treated between February 2014 and July 2017 were included. Patients were allocated to undergo hemiarthroplasty using either an anterolateral or a direct lateral approach, and were followed for 12 months. The mean age of the patients was 81 years (69 to 90), and 109 were women (73%). Functional outcome measures, assessed by a physiotherapist blinded to allocation, and patient-reported outcome measures (PROMs) were collected postoperatively at three and 12 months. Results A total of 11 patients in the direct lateral group had a positive Trendelenburg test at one year compared with one patient in the anterolateral group (11/55 (20%) vs 1/55 (1.8%), relative risk (RR) 11.1; p = 0.004). Patients with a positive Trendelenburg test reported significantly worse Hip Disability Osteoarthritis Outcome Scores (HOOS) compared with patients with a negative Trendelenburg test. Further outcome measures showed few statistically significant differences between the groups. Conclusion The direct lateral approach in patients with a femoral neck fracture appears to be associated with more positive Trendelenburg tests than the anterolateral approach, indicating a poor clinical outcome. Cite this article: Bone Joint J 2019;101-B:793–799.

Direct anterior versus posterolateral approach for bipolar hip hemiarthroplasty in femoral neck fractures: a prospective randomised study

2019 ◽  
Vol 30 (6) ◽  
pp. 810-817
Author(s):  
Simone Verzellotti ◽  
Christian Candrian ◽  
Mauro Molina ◽  
Giuseppe Filardo ◽  
Riccardo Alberio ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Pain Perception ◽  
Group Versus ◽  
Femoral Neck Fractures ◽  
Posterolateral Approach ◽  
Surgical Approaches ◽  
Early Recovery ◽  
Surgical Time ◽  
Clinical Trial Registration ◽  
Hip Hemiarthroplasty

Introduction: Femoral neck fractures are a major problem in orthopaedic practice, having a huge impact on society, and involving a large number of elderly patients for whom early recovery is paramount. Thus, the aim of this study was to compare 2 surgical approaches, direct anterior (DA group) versus posterolateral (PL group), used for bipolar hip hemiarthroplasty (BHA) with femoral neck fractures in order to assess pain recovery after surgery. Our hypothesis was that early pain recovery would be faster in the DA group. Methods: 100 patients were randomised to surgery using either a DA group or PL group approach, and were then followed up for 6 months. Surgical time, intra- and postoperative complications were recorded for each patient. The main outcome, pain, was recorded using an NRS scale at 3 days, 1, 3 and 6 months after surgery. At the same time, patient status was evaluated using Activities of Daily Living and Cumulated Ambulation Score scales. Results: Surgical time was longer in the DA group ( p  < 0.0001). Pain perception at 3 days and at 1 month after surgery was significantly lower in DA group patients ( p  < 0.0001). The results of the other scales were comparable in the 2 groups (at 3 days, 1 and 3 months after surgery). Discussion: The DA approach offers a significant advantage in terms of pain perception up to 1 month after the operation. Early recovery in terms of pain perception is an important finding. Future studies should explore whether this early pain reduction could translate into a faster rehabilitation programme for an earlier recovery of full function. Clinical trial registration: Protocol 423/CE; Study n. CE 41/15.

Outcomes of total hip arthroplasty using dualmobility cups for femoral neck fractures: a systematic review and meta-analysis

2020 ◽  
pp. 112070002092665
Author(s):  
Syed H Mufarrih ◽  
Nada Q Qureshi ◽  
Bassam Masri ◽  
Shahryar Noordin
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Femoral Neck Fractures ◽  
Cochrane Library ◽  
Total Hip ◽  
The Mean

Objectives: Femoral neck fractures (FNFs), with up to 15% mortality, are prominent orthopaedic emergencies. After treating FNFs, dislocation is another challenge increasing morbidity, mortality and treatment costs substantially. The emerging dual-mobility cup (DMC) may decrease dislocation rates following total hip arthroplasty (THA) for FNFs. We performed a systematic review of literature reporting dislocation and mortality rates with DMC-THA for the treatment of FNFs. Methods: 2 authors independently searched PubMed (MEDLINE), Google Scholar and Cochrane library for studies reporting dislocation and mortality rates for FNFs treated with DMC-THA since inception up to January 2019. Data on outcomes of interest was extracted from all studies and assessed for eligibility for a meta-analysis. Results: Out of 522 search results, 18 studies were included in the systematic review and 4 in the meta-analysis. The mean rate of dislocation following DMC-THA for FNFs was found to be 1.87% ± 2.11, with a 1-year mortality rate of 14.0% ± 10.55. Results of meta-analysis showed that dislocation and 1-year postoperative mortality rates were significantly lower for DMC-THA with a risk ratio 0.31 (95% CI, 0.16–0.59; I2 = 0%, p  = 0.0003) and 0.55 (0.40, 0.77; I2 = 0%, p = 0.003) respectively when compared to biploar hemiathroplasty (BHA). Conclusions: The mean dislocation and mortality rates in DMC-THA are lower than previously reported rates for THA with single cup and comparable to unipolar and bipolar hemiarthroplasty. Further research involving randomised control trials to assess differences in outcomes, longevity and cost-effectiveness needs to be conducted to make recommendations for the use of DMC in treating FNFs.

Surgical Approaches and Hemiarthroplasty Outcomes for Femoral Neck Fractures: A Meta-Analysis

2018 ◽  
Vol 33 (5) ◽  
pp. 1617-1627.e9 ◽  
Author(s):  
Max P.L. van der Sijp ◽  
Danny van Delft ◽  
Pieta Krijnen ◽  
Arthur H.P. Niggebrugge ◽  
Inger B. Schipper
Keyword(s):  
Femoral Neck ◽  
Meta Analysis ◽  
Femoral Neck Fractures ◽  
Surgical Approaches

scholarly journals Surgical approach for fracture of distal humerus: Posterior vs lateral

2020 ◽  
Author(s):  
Michela Saracco ◽  
Alessandro Smimmo ◽  
Davide De Marco ◽  
Osvaldo Palmacci ◽  
Giuseppe Malerba ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Radial Nerve ◽  
Posterior Approach ◽  
Age Distribution ◽  
Young Patients ◽  
Lateral Approach ◽  
Humeral Fractures ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Complication Rates

Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.

scholarly journals Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomised control trials

2019 ◽  
Author(s):  
Liu Yijun ◽  
Chen Xiaokun ◽  
Zhang Peixun ◽  
Jiang Baoguo
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Femoral Neck Fractures ◽  
Cochrane Library ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Operation Rate

Abstract Background: Displaced femoral neck fractures (DFNF) are increasingly common in elderly patients. Repair of DFNF can be completed using two methods, hemiarthroplasty (HA) or total hip Arthroplasty (THA). However, there is much controversy regarding whether HA or THA is superior in active elderly patients over 75 years old. Methods: We conducted the literature search by searching PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and Web of Science from the inception dates to June 1, 2019. Randomised controlled trials (RCT) were included according to the inclusion and exclusion criteria. Included studies were analysed according to Cochrane review methods. Results: Nine studies met the inclusion criteria totalling 631 participants (301 THA and 330 HA）. Four of the studies conducted were identical to a previous study but look at different follow up measures. The analysis of previously collected data revealed that the THA group had a lower erosion rate, higher total pain and function HHS, and higher EQ-5Dindex. The re-operation rate was significantly lower in the THA group after five years of follow up after adding the patients with painful symptoms to the group of patients revised. However, THA had longer operative time and a higher dislocation rate in the first three years compared to the HA procedure. Moreover, there was an insignificant difference in mortality rate, general complications, wound infection, duration of hospital stay, and VTE prevalence among the two procedures. Conclusions: THA may be a preferred management option for active elderly patients over 75 years old, after careful evaluation of patients’ general condition and tolerance of surgery. Strict management and follow up protocols should be followed to prevent dislocation within the first three years following a THA. Trial registration: This study was registered at the International Prospective Register of Systematic Reviews (CRD42019139135). The date of registration is 16-06-2019. Keywords: displaced femoral neck fractures; total hip arthroplasty; hemiarthroplasty;

Corrigendum to ‘Surgical Approaches and Hemiarthroplasty Outcomes for Femoral Neck Fractures: A Meta-Analysis’ [The Journal of Arthroplasty 33 (2018) 1617-1627]

2020 ◽  
Vol 35 (2) ◽  
pp. 603-604
Author(s):  
Max P.L. van der Sijp ◽  
Danny van Delft ◽  
Pieta Krijnen ◽  
Arthur H.P. Niggebrugge ◽  
Inger B. Schipper
Keyword(s):  
Femoral Neck ◽  
Meta Analysis ◽  
Femoral Neck Fractures ◽  
Surgical Approaches
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