Surgical approaches for inserting hemiarthroplasty of the hip

Arthroplasty (total hip replacement) involves replacing both the socket in the hip and the thigh side of the joint with an artificial joint. Hemiarthroplasty (partial hip replacement) leaves the socket intact, replacing only the thigh side. This is used for some people with hip fractures. Anterior surgery (from the front) might reduce the risk of dislocation and damaging the sciatic nerve for the leg, while posterior surgery (from the back) may reduce operating time and lower the risk of fracture. However, the review of trials did not find enough evidence to show which type of surgery for hemiarthroplasty is best.

Authors' conclusions: 

There is currently insufficient evidence from randomised trials to determine the optimum surgical approach for insertion of a hemiarthroplasty to the hip.

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Background: 

The operation of insertion of a hemiarthroplasty to the hip refers to replacement of the femoral head with a prosthesis, whilst retaining the natural acetabulum and acetabular cartilage. The main surgical approaches to the hip for insertion of the prosthesis can be broadly categorised as either 'anterior' via the anterior joint capsule, or 'posterior' through the posterior joint capsule.

Objectives: 

To evaluate, based on evidence from randomised controlled trials, the effects of different surgical approaches for the insertion of a hemiarthroplasty to the hip has on clinical outcomes.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (up to February 2002). Articles of all languages were considered.

Selection criteria: 

All randomised controlled trials comparing insertion of a hemiarthroplasty by different surgical approaches.

Data collection and analysis: 

Both reviewers independently assessed trial quality, using a 10 item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically.

Main results: 

One randomised trial was identified involving 114 patients. The trial had poor methodology (particularly in susceptibility to selection bias), inadequate follow-up of patients who withdrew, and there was limited reporting of results. Medical complications and mortality from six months to two years appeared greater in the posterior group; this difference in mortality, within the structure of the poor methodology, was statistically significant. No other differences were claimed to be significant.

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