Key messages

• The evidence is still developing, and future studies may change our conclusions.

• We are not confident that one surgical approach (way of accessing the hip joint) compared to another leads to a different outcome for performing daily tasks, health-related quality of life, mobility or functional status, mortality, or pain, within the first four months after surgery.

What is hip hemiarthroplasty?

Hip hemiarthroplasty, or partial hip replacement, is surgery that replaces the ball of the thighbone (femur) with an artificial one, leaving the socket untouched.

Why is this important for people with hip fractures?

Hip fractures are common, especially in older adults. They can be very painful and make it hard to walk or live independently. Partial hip replacement is a way to fix these fractures, reducing pain, and getting people back on their feet faster. There are different ways to access the hip joint during surgery (approaches). Each has its own benefits and drawbacks.

What did we want to find out?

We wanted to find out what effect different surgical approaches for performing a partial hip replacement can have on a person recovering from surgery.

What did we do?

We searched for studies comparing different approaches for partial hip replacement. Studies had to choose people at random (or use their dates of birth or alternate methods) for each approach and then follow their recovery after surgery. Studies included adults with hip fractures. We compared and summarised the study results, and rated our confidence in the evidence, based on factors such as study size and methods.

What did we find?

We found 27 studies with 3369 people. Studies took place throughout Europe and Asia. The biggest study had 843 people and the smallest study had 29 people. Studies lasted from 40 days to five years.

Anterior versus posterior approaches: there may be little to no difference between the two approaches in how well people can perform daily tasks, their functional status, mortality, or pain at three months after surgery, but we are very uncertain about the results. No studies looked at health-related quality of life within four months of surgery.

Anterior versus lateral approaches: there may be little to no difference between the two approaches in how well people can perform daily tasks, or in their functional status or pain at three months after surgery, but we are very uncertain about the results. We found the anterior approach may reduce the presence of a limp slightly at three months after surgery. No studies looked at health-related quality of life within four months of surgery. We are unsure of the effect on mortality within four months of surgery.

Lateral versus posterior approaches: there may be little to no difference between the two methods in how well people can perform daily tasks, or in their health-related quality of life, functional status or pain at three months after surgery, but we are very uncertain about the results. There may also be no difference between the methods in the risk of dying within three months of surgery.

What are the limitations of the evidence?

In general, we have low or very low confidence in the current level of evidence. Two primary factors reduced our confidence in the evidence. First, there were not enough people in the studies to be certain about their findings, and the results were very inconsistent across the different studies. Second, small study sizes limited the ability to detect rare but clinically important unwanted effects, which were often not reported or were inadequately described.

How up to date is this evidence?

The evidence is up to date to 1 November 2024. Studies were published between 1981 and 2024.