A scoping review comparing two common surgical approaches to the hip for hemiarthroplasty

Abstract

Background Hemiarthroplasty for hip fracture is a common surgical procedure. A number of distinct approaches are used to access the hip joint. The most commonly used are the direct lateral approach (DLA), and the posterior approach (PA). Internationally there is little consensus on which of these approaches to use. Current guidance is based on a limited selection of evidence and choice of approach is frequently based on surgeon preference. Historically, recommendations have been made based on dislocation rates. In light of technical advancements and greater recognition of patient priorities, outcomes such as post-operative function and pain may be considered more important in the modern context. The aim of this scoping review was to summarise the literature pertaining to the comparison of common surgical approaches to the hip for hemiarthroplasty. Methods A scoping review methodology was used to examine the range and nature of primary research. Using systematic methods we searched for studies that directly compared the DLA and PA. Studies reporting the following outcomes were considered; dislocation, mortality, pain, activities of daily living, functionality, health-related quality of life, length of stay, surgeon assessment of difficulty, and adverse events. MEDLINE, EMBASE and The Cochrane Library were searched. Relevant information was extracted and synthesis of the retrieved data followed a basic content analytical approach. Results A total of 13 studies were retrieved: 12 observational studies and 1 randomised trial. The majority of studies were based at single sites. Larger observational studies using multi-site and national registry data have emerged in recent years. Reporting of technique and outcomes is inconsistent. A trend for higher rates of dislocation using the PA was observed and eight studies recommended the use of the DLA over the PA. Conclusions This scoping review demonstrates that the existing evidence is highly heterogeneous in nature and not of a sufficient quality to inform practice recommendations. This issue would be best addressed by additional RCTs, and high quality national-level observational data. Standardisation of the recording of patient risk factors, surgical and post-operative intervention protocols, and outcomes in all study designs would strengthen the potential for valid comparison of future findings.

Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

“…Acetabular anteversion angle (AAA), posterior acetabular sector angle (PASA), posterior wall angle (PWA), and acetabular roofing (%) were evaluated from CT scans. Methodology described by Fullam et al [15] was used for radiological evaluation. In short, an inter-capital centre line (ICL) was drawn on true axial images through both femoral heads at the point of maximum diameter in all 3 planes.…”

“…Dislocation after BHA seems to be independent from the surgical approach [15]. A recent study has reported that posterior wall acetabular morphology may influence hip stability [16].…”

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…Rogmark and Leonardsson published a review of RCTs and register studies reporting an increased risk of dislocation with PA, and given the seriousness of dislocations they suggest that DLA is preferable (89). A recent review article by Fulham (2019) on DLA versus PA described observational studies (85,(90)(91)(92) recommending the DLA based on higher risk of posterior dislocation, but concluded that the evidence is limited and that the topic needs further investigation (93 probably less used due to its learning curve and surgeons' choice (106).…”

Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

“…Many surgical approaches are used in THA surgery, but there is little evidence indicating which approach has the most advantages [5,6] . On the one hand, the direct anterior approach (DAA) is considered a true minimally invasive approach because it leads to a small amount of muscle damage, as the operation is performed through a small incision and a muscle gap in the hip joint [7,8] .…”