Management of femoral neck fractures with the ALMIS approach in elderly patients: Outcomes compared to posterior approach

Tsailas, Panagiotis G.; Argyrou, Chrysoula; Valavanis, Athanasios

doi:10.1016/j.injury.2021.06.036

Cited by 6 publications

(8 citation statements)

References 26 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 ]. The DA and the PL approach were compared in 10 studies [ 12 , 15 , 30 , 31 , 32 , 33 , 41 , 49 , 50 , 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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“…They found limited complication rate, similar to that observed with the PL, strongly suggesting that ALMI is a safe and valid technique for elderly patients with FNFs requiring joint replacement (THA or HHA). 32 …”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures

Innocenti

Lepri

Civinini

et al. 2023

Geriatr Orthop Surg Rehabil

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Introduction Total hip arthroplasty (THA) performed for femoral neck fractures (FNFs) is becoming a more frequent treatment in the active elderly population. Since there is limited research available presenting clinical outcomes after THA using the anterior-based muscle sparing (ABMS) approach, the aim of this study was to compare this surgical approach to the direct lateral (DL) approach in patients treated by THA for FNFs. Materials and Methods We retrospectively reviewed the data prospectively collected as a part of our “Hip Fracture Unit” and included 163 patients who underwent THA from January 2016 to January 2019 for acute displaced FNFs. Results A total of 132 patients who completed a minimum 2-years follow up (69 in the ABMS group and 63 in DL group) were included. The ABMS group demonstrated significantly shorter time to reach milestone for hospital discharge (1.5 Days vs 2.1 days, P = .018), while no statistically significant differences were detected in peri-operative complications. At 3 months, the timed up and go test, the Harris Hip Score (HHS) and the Oxford ip Score (OHS) were significantly better ( P = .024, .032 and .034, respectively) in the ABMS group compared to the DL group. No differences were found in functional outcomes (HHS and OHS) nor in complication rate at 6, 12 and 24 months. Discussion This is one of the first studies to analyze functional results of THA performed for FNFs through an ABMS approach. Results are in line with those already present in the Literature. Conclusion ABMS approach allows earlier mobilization and better early functional outcomes, compared to DL approach, in patients undergoing THA for acute displaced FNF. No differences are found after 6 months in functional results and complications rate.

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“…Filippini et al showed that in the posterior approach, there was less blood loss than in the anterolateral approach [ 16 ]. Tsailas et al showed that there was no difference in blood loss between posterior and anterolateral approaches in patients who underwent hemiarthroplasty due to femoral neck fracture [ 17 ]. In the current study, there was no significant difference in bleeding between the anterolateral and posterior approaches.…”

Section: Discussionmentioning

confidence: 99%

Does the Surgical Approach Influence Bleeding in Hip Fracture Patients Taking Clopidogrel?

Kılıç,

Bingöl,

Ozdemir

et al. 2023

Cureus

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Background The aim of this study was to evaluate the effect of the choice of approach on bleeding in patients with femoral neck fractures who are on clopidogrel. Materials and methods The study included patients over the age of 60 who were taking clopidogrel and had hemiarthroplasty surgery for a femoral neck fracture. A total number of 61 patients were evaluated in the study. Patients who underwent surgery using the posterior approach were assigned to group 1, while those who underwent surgery using the anterolateral approach were assigned to group 2. Preoperative and postoperative hemoglobin levels, transfusion needs, red blood cell (RBC) loss, duration of surgery, and the length of hospitalization were evaluated. Results The mean age of the patients was 79.36 ± 7.72 years. Twenty-nine patients were included in group 1 and 32 patients were included in group 2. There was no significant difference between the two groups in terms of gender, age, and comorbidities (p=0.74, p=0.12, p=0.23, respectively). There were no significant differences between group 1 and group 2 in terms of duration of surgery and length of hospital stay (p=0.41, p=0.37, respectively). Also, there was no significant difference in RBC loss between group 1 and group 2 (p=0.37). Conclusion The use of anterolateral or posterior approaches has no effect on bleeding in clopidogrel-treated patients having hemiarthroplasty for femoral neck fracture. The authors recommend surgeons choose the approach according to their experience and patients' needs.

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Management of femoral neck fractures with the ALMIS approach in elderly patients: Outcomes compared to posterior approach

Cited by 6 publications

References 26 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

Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures

Does the Surgical Approach Influence Bleeding in Hip Fracture Patients Taking Clopidogrel?

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