A comparison of different surgical approaches to hemiarthroplasty for the femoral neck fractures: A meta-analysis

Liang, Shuai; Wu, Huiwen; Shihao, Deng; Wang, Fangyuan; Juehua, Jing; Li, Jun

doi:10.3389/fsurg.2022.1049534

Cited by 3 publications

(4 citation statements)

References 49 publications

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“…Prosthetic hip dislocation is a documented complication of all HA surgical approaches, with some data suggesting dislocation may be more commonly associated with a PA. Kunkel et al noted a significantly lower dislocation rate after a DAA HA for FNF than a PA among 9 pooled studies with 330 DAA and 108 PA 16 . Similar findings have been reported throughout retrospective and registry data, including among total hip arthroplasty (THA) literature 1,3,34,35 . However, the only network meta-analysis of RCTs comparing primary THA approaches found no difference in dislocation by final follow-up 36 .…”

Section: Discussionsupporting

confidence: 84%

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A Comparison of Surgical Approaches for Hip Hemiarthroplasty Performed for the Treatment of Femoral Neck Fracture

Gusho,

Hoskins,

Ghanem

2024

JBJS Reviews

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Background: Multiple hemiarthroplasty (HA) approaches exist for femoral neck fracture (FNF) treatment. However, there is no consensus on the superiority of one approach for postoperative outcomes. This study assessed outcomes among randomized controlled trials (RCTs) comparing the posterior approach (PA), direct lateral approach (DLA), anterolateral approach (ALA), and the direct anterior approach (DAA) in HA for FNF. Methods: PubMed, Ovid/MEDLINE, Scopus, Cochrane Central Registry of Controlled Trials, and Cochrane Database of Systematic Reviews were queried in February 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared outcomes among approaches using P-scores. Results: Of 1,481 retrieved studies, 11 RCTs totaling 1,513 FNF patients who underwent HA through a PA (n = 446; 29.5%), DLA (n = 481; 31.8%), ALA (n = 296; 19.6%), or DAA (n = 290; 19.2%) with median (interquartile range) follow-up of 6 (4.5-12.0) months were included for meta-analysis. DAA was associated with statistically increased operative duration (mean difference [MD], 1.89 minutes; 95% CI, 0.08 to 3.69 minutes; p < 0.001) compared with a PA, whereas an ALA was associated with statistically greater blood loss compared with a PA (MD, 5.81 mL; 95% CI, 4.11 to 7.50 mL; p < 0.001). There were no differences in the incidence of fracture, dislocation, infection, complications, revision, nor 1-year mortality among approaches. There were also no differences in hip nor pain score improvement at latest follow-up, although with high heterogeneity (I2 = 85.7% and 94.2%, respectively). Conclusion: This study found no clinical difference in improvement in pain, function, nor in revision outcomes and operative characteristics among HA approaches for FNF, and each approach had a similar adverse event profile. Despite limited randomized evidence, these findings suggest comparable short-term efficacy and safety of all approaches. Level of Evidence: Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 84%

“…24.00067 HA include the posterior approach (PA), anterolateral approach (ALA), direct lateral approach (DLA), and direct anterior approach (DAA). Each approach has its own complication profile and may influence pain or functional recovery differently [3][4][5][6] . Furthermore, the DAA has recently become popularized among HA surgical approaches.…”

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confidence: 99%

A Comparison of Surgical Approaches for Hip Hemiarthroplasty Performed for the Treatment of Femoral Neck Fracture

Gusho,

Hoskins,

Ghanem

2024

JBJS Reviews

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“…The surgical technique discussed in this paper utilises the direct lateral approach. Shuai at al., found that the posterior approach had a higher risk of dislocation and need for reoperation that the anterior and lateral approaches while the anterior approach had shorter lengths of hospitalisation and less postoperative pain [14]. Furthermore, Parker et al, concluded that rates of medical complications such as pneumonia, congestive cardiac failure and urinary tract infection, and mortality rates at six months, one year and two years, were higher in the posterior approach than the anterior approach while the anterior approach appeared to have a higher rate of pain at one month after surgery and impaired mobility [15].…”

Section: Hip Reduction and Completion Of Hemiarthroplastymentioning

confidence: 94%

“…There were no significant differences in infection, pulmonary embolism, myocardial infection, mortality rates, or need for a reoperation between hemiarthroplasties and total hip arthroplasties [13]. Furthermore, hip hemiarthroplasties can be conducted from an anterior approach, a direct lateral approach or a posterior approach [14]. The surgical technique discussed in this paper utilises the direct lateral approach.…”

Section: Hip Reduction and Completion Of Hemiarthroplastymentioning

confidence: 98%

Femoral Preparation Before Head Dislocation in Hip Hemiarthroplasty for Fractured Neck of Femur Saves Time and Keeps the Acetabulum Clean of loose bone fragments: A Retrospective Study and Technical Report

Shaalan,

Lim

2023

Jap J Clin & Med Res

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Introduction: Femoral neck fractures are the most common traumatic injuries associated with increasing age and osteoporosis, occurring most in older females. The femoral neck is under constant strain from externally and internally generated forces, approximately 500 – 200 micro-strains from daily activities. Common causes are falls in the elderly and road traffic accidents in younger patients. There is a significant in-house mortality and one-year mortality rate associated with femoral fractures. Fractures can be classified using the Garden Classification or the 2018 AO/OTA classification. Management includes open reduction and internal fixation, cannulated or sliding screws and hemiarthroplasty or total hip arthroplasty. This study examines the benefits of femoral preparation before head dislocation in hip hemiarthroplasties by assessing differences between pre-operative and post-operative haemoglobin levels and surgical times. Methods: We report the surgical techniques of hip hemiarthroplasty where the femur is prepared before the femoral head is removed and the hip is reduced in the flexion position. A retrospective review of electronic patient records of patients who underwent hemiarthroplasties from June 2022 to June 2023 was conducted. Results: Surgical times for this surgical technique were 30 minutes faster than traditional methods while the differences in haemoglobin levels were minimal. Conclusion: Longer surgical times are associated with adverse events such as infections and wound dehiscence while increasing risks via surgeon fatigue and longer anaesthesia durations. Innovations in surgical techniques should thus aim to minimise surgical time without compromising procedures. This technique saves 30 min on average while having similar levels of blood loss to traditional techniques, maintaining standards, and not compromising on patient safety. Femoral preparation before dislocating the femoral head reduces the steps taken in leg repositioning which saves time and effort by the assistant. The reduction technique also avoids any risk of intra-operative iatrogenic fracture that can happen, especially if the assistant is a junior surgeon who lacks experience with hip reduction.

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Enhancing recovery: surgical techniques and rehabilitation strategies after direct anterior hip arthroplasty

Di Martino,

Keating,

Butsick

et al. 2024

J Orthop Traumatol

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Total hip arthroplasty (THA) is a common surgical procedure for hip joint pathologies, with the direct anterior approach (DAA) gaining popularity due to potential benefits in postoperative recovery. This review aims to provide a comprehensive analysis of rehabilitation strategies following DAA THA, focusing on surgical techniques, postoperative care, and outcomes. The evolution of the DAA to THA is discussed, highlighting historical advancements and comparisons with other surgical approaches. Surgical techniques and considerations specific to the DAA are detailed, including outcomes and complications compared to alternative approaches. The role of the surgical technique in influencing postoperative rehabilitation is explored, emphasizing the importance of optimizing surgical procedures for enhanced recovery. Postoperative care and rehabilitation models following DAA THA are examined, with a focus on the impacts of different rehabilitation protocols on patient outcomes. The review underscores the significance of tailored rehabilitation programs in promoting optimal recovery and patient satisfaction. Current evidence from recent studies, meta-analyses, and clinical trials is critically analyzed to provide insights into the effectiveness of postoperative rehabilitation strategies. The review identifies gaps in the existing literature and proposes recommendations for future research to improve rehabilitation protocols and enhance outcomes. In conclusion, this review highlights the importance of postoperative rehabilitation in the context of DAA THA. By synthesizing historical perspectives, current evidence, and future directions, the review offers a comprehensive understanding of rehabilitation strategies following DAA THA. The findings underscore the need for personalized rehabilitation programs and ongoing research to optimize postoperative recovery and improve outcomes in the field of THA.

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A comparison of different surgical approaches to hemiarthroplasty for the femoral neck fractures: A meta-analysis

Cited by 3 publications

References 49 publications

A Comparison of Surgical Approaches for Hip Hemiarthroplasty Performed for the Treatment of Femoral Neck Fracture

A Comparison of Surgical Approaches for Hip Hemiarthroplasty Performed for the Treatment of Femoral Neck Fracture

Femoral Preparation Before Head Dislocation in Hip Hemiarthroplasty for Fractured Neck of Femur Saves Time and Keeps the Acetabulum Clean of loose bone fragments: A Retrospective Study and Technical Report

Enhancing recovery: surgical techniques and rehabilitation strategies after direct anterior hip arthroplasty

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