Lateral and Posterior Approaches in Hemiarthroplasty

Hongisto, Markus T; Nuotio, Maria; Luukkaala, Tiina; Väistö, Olli; Pihlajamäki, Harri

doi:10.1177/1457496917748226

Cited by 23 publications

(36 citation statements)

References 28 publications

(34 reference statements)

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“…Although hemiarthroplasty has been effectively applied to increase patient satisfaction in the treatment of displaced femoral neck fractures in elderly patients, death rates in the first postoperative year were reported to be 16%–29% in many studies 14293031. The mortality rate in our study was in agreement with the literature in the 1 st year after surgery.…”

Section: Discussionsupporting

confidence: 91%

Efficacy of Different Posterior Capsulotomies on Dislocations in Hip Hemiarthroplasty: T-Shaped Capsulotomy versus Longitudinal Capsulotomy

Yılmaz

2019

IJOO

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Background: Dislocation following hip hemiarthroplasty is one of the leading reasons necessitating a resurgery. Many studies suggested that the type of the surgical approach is the main cause for dislocation. However, no consensus has been reached yet regarding the type of the surgical approach. In this prospective clinical study, we aimed to compare the efficacy of two different capsulotomy techniques on dislocations, applied during hip hemiarthroplasties performed through the posterior approach. Materials and Methods: We investigated the dislocation rates in 287 patients (aged 65 and above) who underwent cemented bipolar hemiarthroplasty for displaced femoral neck fractures through the posterior capsular approach using two different capsulotomy techniques between 2009 and 2016. Patients were followed up for 12 months after hemiarthroplasty. Patients were evaluated in two groups; on whom hemiarthroplasty was performed as longitudinal (146 patients) and as T-shaped capsulotomy (141 patients). Results: Posterior dislocations occurred in seven (5%) patients who underwent hemiarthroplasty with T-shaped capsulotomy. No dislocation was observed in 146 patients who underwent hip hemiarthroplasty through posterior longitudinal capsulotomy. The difference between the two study groups was statistically significant ( P < 0.007). Conclusion: Capsule integrity can be achieved through a strong capsule repair which is possible through hemiarthroplasty with longitudinal capsulotomy. Longitudinal capsulotomy is an effective technique in preventing dislocations following hip hemiarthroplasty.

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Section: Discussionsupporting

confidence: 91%

Efficacy of Different Posterior Capsulotomies on Dislocations in Hip Hemiarthroplasty: T-Shaped Capsulotomy versus Longitudinal Capsulotomy

Yılmaz

2019

IJOO

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“…The posterolateral approach was an independent risk factor for dislocation as shown earlier (Leonardsson et al 2012, Rogmark et al 2014, Moerman et al 2018. The posterolateral approach could be considered as surgical approach in HA because functional outcome including pain, walking without mobility aids, and patient-reported outcome measures have been shown to be in favor of the posterolateral approach (Kristensen et al 2017, Hongisto et al 2018. We could not measure the functional outcome.…”

Section: Discussionmentioning

confidence: 86%

Mortality and revision rate of cemented and uncemented hemiarthroplasty after hip fracture: an analysis of the Dutch Arthroplasty Register (LROI)

et al. 2020

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“…Of the 12 included articles 1 was a RCT, 24 3 were prospective studies, 9,25,26 3 were registry studies 10,12,27 and 5 were retrospective studies. 11,[28][29][30][31]…”

Section: Search Resultsmentioning

confidence: 99%

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

et al. 2020

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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.

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Lateral and Posterior Approaches in Hemiarthroplasty

Abstract: Hemiarthroplasty using a lateral approach predisposed to the need for ambulatory aids 1 year after hip fracture. The posterior approach, however, predisposed to hip dislocation. Patient selection must be considered when deciding the appropriate surgical approach.

Cited by 23 publications

References 28 publications

Efficacy of Different Posterior Capsulotomies on Dislocations in Hip Hemiarthroplasty: T-Shaped Capsulotomy versus Longitudinal Capsulotomy

Efficacy of Different Posterior Capsulotomies on Dislocations in Hip Hemiarthroplasty: T-Shaped Capsulotomy versus Longitudinal Capsulotomy

Mortality and revision rate of cemented and uncemented hemiarthroplasty after hip fracture: an analysis of the Dutch Arthroplasty Register (LROI)

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

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