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· DOS Abstracts
Lateral vs. posterior approach to the hip
in patients with hip fractures treated with
hemiarthroplasty. A systematic review with
meta-analysis.
Komal Tariq, Lisa Forkman, Julie Erichsen, Søren Overgaard, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Odense University
Hospital and Institute of Clinical Research, University of Southern Denmark,
University of Southern Denmark/Odense University Hospital;
Background:
Register studies have advocated for the use of the lateral ap-
proach (LA) to the hip instead of the posterior approach (PA) when performing
hemiarthroplasty surgery in order to reduce subsequent hip dislocation.
Purpose / Aim of Study:
The aim was to conduct a systematic review with
meta-analysis to compare LA with PA in terms of major and minor complications
(register studies not included).
Materials and Methods:
On October 16th 2015 an electronic search of
PubMed, Embase and Cochrane databases was performed. Two authors inde-
pendently screened 4802 articles by title, abstract, and finally full text of 28
eligible articles was read. Data on demographics and complications was extract-
ed by two authors and re-checked by further two authors. Complications were
grouped into minor (no surgery) or major (open surgery) complications. The
quality of studies was assessed according to Risk of Bias Assessment Tool for
Nonrandomized Studies. Meta-analysis was only performed for dislocation due
to lack of reporting for other complications.
Findings / Results:
Six studies compromising 3348 patients, LA 1969 and PA
1379, was included thereof one RCT. The median follow-up ranged from 6-28
months. The quality of the cohort studies was in general low with high risk of
bias. The risk ratio (95 % CI) for LA was 0.27 (0.17;0.41) for dislocation com-
pared to PA. Only 2 studies had information on the major complications. One
study was a cohort study showing difference in total revisions due to peripros-
tethic fractures but included old cemented and uncemented stem designs. The
other was the RCT which showed no differences in any parameter between LA
and PA, and was the only study using a piriformis preserving approach.
Conclusions:
LA demonstrates a 27 % reduced risk of dislocation, but in a RCT
no difference was seen, which may be due to a piriformis preserving technique.
No conflicts of interest reported
125.