Hemiarthroplasty of the hip — the anterior or posterior approach? A comparison of surgical approaches

Keene, G; Parker, Martyn J.

doi:10.1016/0020-1383(93)90125-p

Cited by 63 publications

(46 citation statements)

References 14 publications

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“…Our results of 6.6% reoperation and 2.9% dislocation rates conform well with other studies on HAs using an anterolateral surgical approach [1,3,18,19]. Although the frequency of dislocation is relatively low when using an anterolateral surgical approach [14,20], the percentage of patients with at least one recurrent dislocation after a first closed reduction of an HA is high, up to 50% [14,18,21], and revision surgery is reported to occur in 35-50% of the patients suffering from a dislocated hip prosthesis [7][8][9]. Furthermore, recurrent dislocations have a negative effect on the quality of life [22], cause additional hospital costs [23] and may contribute to an increased mortality rate [24].…”

Section: Discussionsupporting

confidence: 89%

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures

Enocson

Hedbeck

Törnkvist

et al. 2011

International Orthopaedics (SICOT)

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Background Hip replacement using a hemiarthroplasty (HA) is a common surgical procedure in elderly patients with fractures of the femoral neck. Data from the Swedish Hip Arthroplasty Register suggest that there is a higher risk for revision surgery with the bipolar HA compared with the unipolar HA. Purpose In this study we analysed the reoperation and the dislocation rates for Exeter HAs in patients with a displaced femoral neck fracture, comparing the unipolar and bipolar prosthetic designs. Additionally, we compared the outcome for HAs performed as a primary intervention with those performed secondary to failed internal fixation. Methods We studied 830 consecutive Exeter HAs (427 unipolar and 403 bipolar) performed either as a primary operation for a displaced fracture of the femoral neck or as a secondary procedure after failed internal fixation of a fracture of the femoral neck. Cox regression analyses were performed to evaluate factors associated with reoperation and prosthetic dislocation. Age, gender, the surgeon's experience, indication for surgery (primary or secondary) and type of HA (unipolar or bipolar) were tested as independent variables in the model. Results The prosthetic design (uni-or bipolar) had no influence on the risk for reoperation or dislocation, nor had the age, gender or the surgeon's experience. The secondary HAs were associated with a significantly increased risk for reoperation (HR 2.6, CI 1.5-4.5) or dislocation (HR 3.3,3) compared to the primary HAs. We found no difference in the risk for reoperation or dislocation when comparing Exeter unipolar and bipolar HAs, but special attention is called for to reduce the risk of prosthesis dislocation and reoperation after a secondary HA.

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Section: Discussionsupporting

confidence: 89%

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures

Enocson

Hedbeck

Törnkvist

et al. 2011

International Orthopaedics (SICOT)

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“…This finding is in agreement with the re-dislocation rate of 50% reported by Blewitt and Mortimer (1992). The high rate of re-dislocations necessitating repeated closed reductions or open revision surgery may be one explanation for the high mortality rate previously reported (Blewitt andMortimore 1992, Keene andParker 1993).…”

Section: Discussionmentioning

confidence: 89%

“…In a prospective study involving 531 patients, Keene and Parker (1993) reported an increased dislocation rate using the posterolateral approach. However, they also reported a longer operating time and an increased infection rate and blood loss using the anterior approach.…”

Section: Discussionmentioning

confidence: 99%

Dislocation of hemiarthroplasty after femoral neck fracture: Better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips

et al. 2008

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Background and purpose Hip replacement using a hemiarthroplasty is a common surgical procedure in elderly patients with fractures of the femoral neck. The optimal surgical approach regarding the risk of dislocation is controversial. We analyzed factors influencing the stability of the hemiarthroplasty, with special regard to the surgical approach.Patients and methods We studied 720 consecutive patients on whom 739 hemiarthroplasties were performed between 1996 and 2003, either as a primary operation for a displaced fracture of the femoral neck or as a secondary procedure after failed internal fixation of a fracture of the femoral neck. Logistic regression analyses were performed in order to evaluate factors associated with prosthetic dislocation.Results The multivariate regression analysis showed that the posterolateral approach was the only factor associated with a significantly increased risk of dislocation: OR 3.9 (CI: 1.6-10) for the posterolateral approach with posterior repair and OR 6.9 (CI: 2.6-19) for the posterolateral approach without posterior repair. Age, sex, indication for surgery, the surgeon's experience, and type of HA had no statistically significant effect on the dislocation rate. Interpretation Compared to the anterolateral approach, the posterolateral approach was associated with a significantly increased risk of dislocation in patients with femoral neck fractures treated with HA. A posterior repair appears to reduce the rate of dislocation, although not to the same low level as in patients operated using the anterolateral approach.

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“…4,5 Reasons precautions are not required include the use of large femoral head components (usually >42mm in diameter) and an anterolateral approach. 3,6,7 The prevalence of cognitive impairment and post-operative delirium causes difficulty in implementation of hip precautions in 30% of this population. 8 The use of hip precautions can delay mobilisation, rehabilitation and discharge and can increase patient anxiety.…”

Section: Discussionmentioning

confidence: 99%

Hip precautions after hemiarthroplasty: what is happening in the UK and at what cost?

Fox

Halliday

Barnfield

et al. 2011

annals

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INTRODUCTION The aim of this study was to observe current practice of the use of hip precautions following hemiarthroplasty for hip fractures in England and to audit the cost of hip precautions in this patient group. METHODS A telephone review was undertaken of all units identified by the National Hip Fracture Database as receiving centres for hip fractures across England to ascertain current practice in the use of hip precautions. A prospective audit of occupational therapy (OT) practice including the cost of equipment provision and OT time was carried out locally. RESULTS All 174 units in England were successfully contacted. Practice varied between centres but hip precautions were in use at 78% of centres. Prior to stopping hip precautions at the local hospital, we audited the costs associated with their use. Mean equipment costs per patient decreased by £12 (from £49 to £37, range: £0–£83) and mean OT time per patient decreased by 1.5 hours (from 8 hours to 6.5 hours, range: 1–22 hours) following removal of hip precaution guidelines. A mean of 0.25 days' discharge delay (range: 0–4 days) due to equipment provision was identified prior to removing hip precautions with no discharge delay following. CONCLUSIONS This study has highlighted the variation in practice across the country and inconsistency with the advice published by the British Orthopaedic Association and British Geriatrics Society in the ‘Blue Book’ (The Care of Patients with Fragility Fracture). Hip precautions are unnecessary after hemiarthroplasty, cost money both in therapist time and equipment provision and increase the length of hospital stay. Nevertheless, they continue to be used by three-quarters of trauma hospitals in England.

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Hemiarthroplasty of the hip — the anterior or posterior approach? A comparison of surgical approaches

Cited by 63 publications

References 14 publications

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures

Dislocation of hemiarthroplasty after femoral neck fracture: Better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips

Hip precautions after hemiarthroplasty: what is happening in the UK and at what cost?

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