Hip precautions not meaningful after hemiarthroplasty due to hip fracture. Cluster-randomized study of 394 patients operated with direct anterolateral approach

Jobory, Ammar; Rolfson, Ola; Åkesson, Kristina; Arvidsson, Cecilia; Nilsson, Inger; Rogmark, Cecilia

doi:10.1016/j.injury.2019.05.002

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…A total of 268 studies were found through the electronic search and 3 studies were added follwing cross-referenced research on the bibliography of the examined full-text articles. After a preliminary analysis, a total of 50 studies were included in this systematic review [ 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The DL approach was compared to the AL approach in 3 studies [ 40 , 41 , 57 ], to the DA approach in 8 studies [ 10 , 18 , 39 , 41 , 44 , 46 , 57 , 58 ], and to the PL approach in 18 studies [ 5 , 11 , 20 , 23 , 25 , 26 , 27 , 28 , 34 , 36 , 37 , 40 , 41 , 42 , 45 , 51 , 52 , 57 ]. The AL approach was compared to the DA approach in five studies [ 13 , 41 , 48 , 49 , 57 ], and to the PL approach in nine studies [ 19 , 22 , 24 , 38 , 40 , 41 , 49 , 55 , 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies were randomized control trials [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], six were prospective comparative cohort studies [ 19 , 30 , 31 , 32 , 35 , 37 ], thirty-two were retrospective comparative cohort studies [ 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 33 , 34 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] and three were registry studies [ 5 , 25 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

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Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis

Filippini,

Bortoli,

Montanari

et al. 2023

Medicina

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis

Filippini,

Bortoli,

Montanari

et al. 2023

Medicina

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“…The other interventions with no positive outcomes included multifactorial best practice case management model for incontinence management [ 103 ], standard postoperative hip precautions (which reported no significant differences in the risk of dislocation, patient reported outcome and complications) [ 104 ], and high-protein nutritional supplement enriched with arginine, zinc and antioxidants dose of 400 ml/day for pressure ulcer management [ 105 ].…”

Section: Resultsmentioning

confidence: 99%

Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials

Phang

Lim

Yee

et al. 2023

BMC Musculoskelet Disord

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Background Interventions provided after hip fracture surgery have been shown to reduce mortality and improve functional outcomes. While some systematic studies have evaluated the efficacy of post-surgery interventions, there lacks a systematically rigorous examination of all the post-surgery interventions which allows healthcare providers to easily identify post-operative interventions most pertinent to patient’s recovery. Objectives We aim to provide an overview of the available evidence on post-surgery interventions provided in the acute, subacute and community settings to improve outcomes for patients with hip fractures. Methods We performed a systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). We included articles that were (1) randomized controlled trials (RCTs), (2) involved post-surgery interventions that were conducted in the acute, subacute or community settings and (3) conducted among older patients above 65 years old with any type of non-pathological hip fracture that was surgically treated, and who were able to walk without assistance prior to the fracture. We excluded (1) non–English language articles, (2) abstract-only publications, (3) articles with only surgical interventions, (4) articles with interventions that commenced pre-surgery or immediately upon completion of surgery or blood transfusion, (5) animal studies. Due to the large number of RCTs identified, we only included “good quality” RCTs with Jadad score ≥ 3 for data extraction and synthesis. Results Our literature search has identified 109 good quality RCTs on post-surgery interventions for patients with fragility hip fractures. Among the 109 RCTs, 63% of the identified RCTs (n = 69) were related to rehabilitation or medication/nutrition supplementation, with the remaining RCTs focusing on osteoporosis management, optimization of clinical management, prevention of venous thromboembolism, fall prevention, multidisciplinary approaches, discharge support, management of post-operative anemia as well as group learning and motivational interviewing. For the interventions conducted in inpatient and outpatient settings investigating medication/nutrition supplementation, all reported improvement in outcomes (ranging from reduced postoperative complications, reduced length of hospital stay, improved functional recovery, reduced mortality rate, improved bone mineral density and reduced falls), except for a study investigating anabolic steroids. RCTs involving post-discharge osteoporosis care management generally reported improved osteoporosis management except for a RCT investigating multidisciplinary post-fracture clinic led by geriatrician with physiotherapist and occupational therapist. The trials investigating group learning and motivational interviewing also reported positive outcome respectively. The other interventions yielded mixed results. The interventions in this review had minor or no side effects reported. Conclusions The identified RCTs regarding post-surgery interventions were heterogeneous in terms of type of interventions, settings and outcome measures. Combining interventions across inpatient and outpatient settings may be able to achieve better outcomes such as improved physical function recovery and improved nutritional status recovery. For example, nutritional supplementation could be made available for patients who have undergone hip fracture surgery in the inpatient settings, followed by post-discharge outpatient osteoporosis care management. The findings from this review can aid in clinical practice by allowing formulation of thematic program with combination of interventions as part of bundled care to improve outcome for patients who have undergone hip fracture surgery.

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“…Individuals with either manifest dementia or suspicion of cognitive impairment showed increased risk of dislocation with the posterior approach compared with the direct lateral approach. Although commonly recommended, movement precautions and mandatory use of ADL equipment during the recovery phase do not affect the risk of dislocation when patients are operated on with the direct lateral approach (Jobory et al 2019). Posterior approach has not, to our knowledge, been studied in this context, but many surgeons prescribe movement precautions and mandatory use of ADL equipment to avoid dislocation.…”

Section: Discussionmentioning

confidence: 99%

Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register

et al. 2021

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Background and purpose — Reported revision rates due to dislocation after hemiarthroplasty span a wide range. Dislocations treated with closed reduction are rarely reported despite the fact that they can be expected to constitute most of the dislocations that occur. We aimed to describe the total dislocation rate on the national level, and to identify risk factors for dislocation. Patients and methods — We co-processed a national cohort of 25,678 patients in the Swedish Hip Arthroplasty Register, with the National Patient Register (NPR) and Statistics Sweden. Dislocation was defined as the occurrence of any ICD-10 or procedural code related to hip dislocation recorded in the NPR, with a minimum of 1-year-follow-up. In theory, all early dislocations should thereby be traced, including those treated with closed reduction only. Results — 366/13,769 (2.7%) patients operated on with direct lateral approach dislocated, compared with 850/11,834 (7.2%) of those with posterior approach. Posterior approach was the strongest risk factor for dislocation (OR = 2.7; 95% CI 2.3–3.1), followed by dementia (OR = 1.3; CI 1.1–1.5). The older the patients, the lower the risk of dislocation (OR = 0.98 per year of age; CI 0.98–1.0). Neither bipolar design nor cementless stems influenced the risk. Interpretation — The choice of posterior approach and dementia was associated with an increased dislocation risk. When hips treated with closed reduction were identified, the frequency of dislocation with use of direct lateral and posterior approach more than doubled and tripled, respectively, compared with when only revisions due to dislocation are measured.

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Hip precautions not meaningful after hemiarthroplasty due to hip fracture. Cluster-randomized study of 394 patients operated with direct anterolateral approach

Cited by 11 publications

References 29 publications

Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis

Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis

Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials

Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register

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