The surgical approach for hemiarthroplasty does not influence patient-reported outcome

Leonardsson, Olof; Rolfson, Ola; Rogmark, Cecilia

doi:10.1302/0301-620x.98b4.36626

Cited by 31 publications

(57 citation statements)

References 21 publications

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“…(2016) reported better patient-reported outcome after the posterior approach than after the direct lateral approach. After adjusting for age, sex, cognitive impairment, and ASA grade, however, no statistically significant results were found.…”

Section: Discussionmentioning

confidence: 98%

Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture

et al. 2016

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Background and purpose — Hemiarthroplasty (HA) is the most common treatment for displaced femoral neck fractures in many countries. In Norway, there has been a tradition of using the direct lateral surgical approach, but worldwide a posterior approach is more often used. Based on data from the Norwegian Hip Fracture Register, we compared the results of HA operated through the posterior and direct lateral approaches regarding patient-reported outcome measures (PROMs) and reoperation rate.Patients and methods — HAs due to femoral neck fracture in patients aged 60 years and older were included from the Norwegian Hip Fracture Register (2005–2014). 18,918 procedures were reported with direct lateral approach and 1,990 with posterior approach. PROM data (satisfaction, pain, quality of life (EQ-5D), and walking ability) were reported 4, 12, and 36 months postoperatively. The Cox regression model was used to calculate relative risk (RR) of reoperation.Results — There were statistically significant differences in PROM data with less pain, better satisfaction, and better quality of life after surgery using the posterior approach than using the direct lateral approach. The risk of reoperation was similar between the approaches.Interpretation — Hemiarthroplasty for hip fracture performed through a posterior approach rather than a direct lateral approach results in less pain, with better patient satisfaction and better quality of life. The risk of reoperation was similar with both approaches.

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Section: Discussionmentioning

confidence: 98%

Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture

et al. 2016

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“…In the age group of 60-70 years, some clinics have during recent years shifted towards THA as it is expected to give a better outcome [38]. The treatment of choice in patients younger than 60 years of age is internal fixation [39], as these individuals usually can withstand a secondary arthroplasty as a salvage procedure if the internal fixation fails. Also, those who heal will presumably benefit from keeping their native hip joint.…”

Section: A C C E P T E Dmentioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!

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“…Early mobilization following hip fracture surgery reduces medical complications and mortality [1][2][3]6,10]. The patients in the SPAIRE group in this study were discharged one day earlier compared to the lateral group.…”

Section: Discussionmentioning

confidence: 90%

“…The most commonly used approach for hemiarthroplasty in the UK is the direct lateral approach [2,3] popularised by Hardinge in 1982 [4]. This approach involves section or detachment of part of the gluteus medius and minimus tendons in order to gain access to the hip joint.…”

Section: Introductionmentioning

confidence: 99%

“…This approach has resulted in better patient-reported outcomes as demonstrated by the Norwegian and Swedish Hip Fracture Registers [2,3]. However, the posterior approach is associated with a significantly higher dislocation rate [3]. Patients who undergo hemiarthroplasty are usually frail and it is important to minimise the risk of complications and the need for further operative interventions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Details of a Tendon–Sparing Posterior Approach in Hemiarthroplasty in the Treatment of Displaced Intracapsular Neck of Femur Fracture

Lee¹,

Charity²,

Timperley³

2017

J Arthritis

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This paper details a tendon-sparing surgical technique allowing hemiarthroplasty through a posterior approach in all cases whilst preserving the Quadriceps coxa. The SPAIRE (Sparing Piriformis and Internus, Repair Externus) technique, described by Hanly et al. for routine use in total hip replacement, theoretically offers the functional benefits of the posterior approach with reduced risk of dislocation. It may also facilitate early mobilisation after hip fracture surgery with potential reduction in medical complications and mortality. In this study, we report our initial experience using the same SPAIRE technique for hemiarthroplasty to treat all patients with displaced intracapsular neck of femur fractures, irrespective of skeletal dimension and BMI. Our results suggest that the SPAIRE technique is feasible and safe to be used in all cases requiring hemiarthroplasty. Further research should be encouraged to investigate the role of the SPAIRE technique in fractured neck of femur surgery.

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The surgical approach for hemiarthroplasty does not influence patient-reported outcome

Abstract: The surgical approach for hemiarthroplasty does not seem to affect the patient-perceived HRQoL, residual pain or patient satisfaction one year after surgery on elderly patients. The choice of approach should be based on other factors, such as the risk of dislocation.

Cited by 31 publications

References 21 publications

Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture

Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture

Hip fractures in the non-elderly—Who, why and whither?

Details of a Tendon–Sparing Posterior Approach in Hemiarthroplasty in the Treatment of Displaced Intracapsular Neck of Femur Fracture

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