Skip to main content

Advertisement

SpringerLink
Log in

Complications and early recovery following hip hemiarthroplasty through the direct anterior approach: a systematic review and meta-analysis

  • General Review
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Minimizing complications is an important focus in hip hemiarthroplasty (HHA) for femoral neck fracture (FNF) patients given the associated high morbidity and mortality rates. This systematic review and meta-analysis aimed to compare the clinical and functional outcomes associated with the direct anterior approach (DAA) compared to other surgical approaches used for HHA.

Methods

Studies evaluating HHA-treated FNFs using the DAA were compared through meta-analysis to all other surgical approaches combined and as distinct subgroups. Outcomes included overall complication rate, mortality rate, dislocation rate, reoperation rate, periprosthetic fracture rate, infection rate, length of stay (LOS), mobility, perioperative blood loss, operative time, and postoperative pain.

Results

Nineteen studies met the inclusion criteria, totaling 2,018 HHAs. DAA significantly reduced the overall complication rate (odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.57 to 0.94, p = 0.01), dislocation rate (OR = 0.34, 95% CI 0.15 to 0.77, p = 0.01), and LOS (mean difference (MD) = −1.31 days, 95% CI  − 2.12 to  − 0.50, p = 0.002). Findings from studies that were not appropriate for meta-analysis were qualitatively summarized and suggested improved mobility and reduced postoperative pain with the DAA. Significant differences were not detected in any of the remaining outcomes.

Conclusion

The DAA HHA appears to be safer, reduces hospital stay, and may improve early functional recovery. This article supports the DAA HHA as a safe option for the management of displaced intracapsular FNFs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop 10(3):166–175

    Article  PubMed  PubMed Central  Google Scholar 

  2. Thorngren KG et al (2002) Epidemiology of femoral neck fractures. Injury 33(Suppl 3):C1-7

    Article  PubMed  Google Scholar 

  3. Ju DG et al (2017) Nationwide Analysis of Femoral Neck Fractures in Elderly Patients: A Receding Tide. J Bone Joint Surg Am 99(22):1932–1940

    Article  PubMed  Google Scholar 

  4. van der Sijp MPL et al (2018) Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis. J Arthroplasty 33(5):1617–1627

    Article  PubMed  Google Scholar 

  5. Verzellotti S et al (2020) Direct anterior versus posterolateral approach for bipolar hip hemiarthroplasty in femoral neck fractures: a prospective randomised study. Hip Int 30(6):810–817

    Article  PubMed  Google Scholar 

  6. Neyisci C et al (2020) Direct anterior approach versus posterolateral approach for hemiarthroplasty in the treatment of displaced femoral neck fractures in geriatric patients. Med Sci Monit 26:e919993

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pala E et al (2016) Hip hemiarthroplasty for femur neck fractures: minimally invasive direct anterior approach versus postero-lateral approach. Eur J Orthop Surg Traumatol 26(4):423–427

    Article  CAS  PubMed  Google Scholar 

  8. Kunkel ST et al (2018) A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol 28(2):217–232

    Article  PubMed  Google Scholar 

  9. Fullam J et al (2019) A scoping review comparing two common surgical approaches to the hip for hemiarthroplasty. BMC Surg 19(1):32

    Article  PubMed  PubMed Central  Google Scholar 

  10. Langlois J et al (2015) Direct anterior Hueter approach is a safe and effective approach to perform a bipolar hemiarthroplasty for femoral neck fracture: outcome in 82 patients. Acta Orthop 86(3):358–362

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lakhani K et al (2022) Direct anterior approach provides better functional outcomes when compared to direct lateral approach in hip hemiarthroplasty following femoral neck fracture. Eur J Orthop Surg Traumatol 32(1):137–143

    Article  PubMed  Google Scholar 

  12. Ladurner A et al (2022) Direct anterior approach improves in-hospital mobility following hemiarthroplasty for femoral neck fracture treatment. Arch Orthop Trauma Surg 142(11):3183–3192

    Article  CAS  PubMed  Google Scholar 

  13. Kyriakopoulos G, Poultsides L, Christofilopoulos P (2018) Total hip arthroplasty through an anterior approach: The pros and cons. EFORT Open Rev 3(11):574–583

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lovell TP (2008) Single-incision direct anterior approach for total hip arthroplasty using a standard operating table. J Arthroplasty 23(7 Suppl):64–68

    Article  PubMed  Google Scholar 

  15. Saxer F et al (2018) Minimally invasive anterior muscle-sparing versus a transgluteal approach for hemiarthroplasty in femoral neck fractures-a prospective randomised controlled trial including 190 elderly patients. BMC Geriatr 18(1):222

    Article  PubMed  PubMed Central  Google Scholar 

  16. Moher D et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  17. Preininger B et al (2011) Earlier postoperative mobilization with minimally invasive hip hemiarthroplasty. Unfallchirurg 114(4):333–339

    Article  CAS  PubMed  Google Scholar 

  18. Walpole SC (2019) Including papers in languages other than English in systematic reviews: important, feasible, yet often omitted. J Clin Epidemiol 111:127–134

    Article  PubMed  Google Scholar 

  19. Drevon D, Fursa SR, Malcolm AL (2017) Intercoder Reliability and Validity of WebPlotDigitizer in Extracting Graphed Data. Behav Modif 41(2):323–339

    Article  PubMed  Google Scholar 

  20. Sterne JAC et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898

    Article  PubMed  Google Scholar 

  21. Sterne JA et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  22. Luo D et al (2018) Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 27(6):1785–1805

    Article  PubMed  Google Scholar 

  23. Wan X et al (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  PubMed  PubMed Central  Google Scholar 

  24. Drahota ABE (2020) RevMan Calculator. Available from: https://training.cochrane.org/resource/revman-calculator. Accessed 5 June 2022

  25. Higgins JP et al (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  26. Auffarth A et al (2011) Does the choice of approach for hip hemiarthroplasty in geriatric patients significantly influence early postoperative outcomes? A randomized-controlled trial comparing the modified Smith-Petersen and Hardinge approaches. J Trauma 70(5):1257–1262

    PubMed  Google Scholar 

  27. Bucs G et al (2021) Bipolar hemiarthroplasty for the treatment of femoral neck fractures with minimally invasive anterior approach in elderly. Injury 52(Suppl 1):S37–S43

    Article  PubMed  Google Scholar 

  28. Baba T, Shitoto K, Kaneko K (2013) Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 4(2):85–89

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tsukada S, Wakui M (2010) Minimally invasive intermuscular approach does not improve outcomes in bipolar hemiarthroplasty for femoral neck fracture. J Orthop Sci 15(6):753–757

    Article  PubMed  Google Scholar 

  30. Renken F et al (2012) Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach. BMC Musculoskelet Disord 13:141

    Article  PubMed  PubMed Central  Google Scholar 

  31. Carlson VR et al (2017) The direct anterior approach does not increase return to function following hemiarthroplasty for femoral neck fracture. Orthopedics 40(6):e1055–e1061

    Article  PubMed  Google Scholar 

  32. Trinh TQ et al (2015) Short-term outcomes of femoral neck fractures treated with hemiarthroplasty using the anterior approach. Orthopedics 38(12):e1091–e1097

    Article  PubMed  Google Scholar 

  33. Faggiani M et al (2022) Comparison of anterior and lateral approach in hip hemiarthroplasty for femur neck fractures in the elderly: clinical and radiographic outcomes. Malays Orthop J 16(3):113–119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Orth M et al (2022) Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures. Arch Orthop Trauma Surg

  35. Krassnig R et al (2022) Direct anterior versus antero-lateral approach in hip joint hemiarthroplasty. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04685-x

    Article  PubMed  Google Scholar 

  36. Yazdanpanah PM (2020) Hamidreza, Short-term complications of hip bipolar hemiarthroplasty with anterior approach in patients with femoral neck fracture admitted to the emergency department of Yasuj Shahid Beheshti Hospital in 2016–2018. Revista Latinoamericana de Hipertensión 15(n2):150–153

    Google Scholar 

  37. Spaans AJ, van den Hout JA, Bolder SB (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83(4):342–346

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nogler M et al (2021) Hemiarthroplasty of the hip using the direct anterior approach. Oper Orthop Traumatol 33(4):304–317

    PubMed  PubMed Central  Google Scholar 

  39. Patel NN, Shah JA, Erens GA (2019) Current trends in clinical practice for the direct anterior approach total hip arthroplasty. J Arthroplasty 34(9):1987–1993

    Article  PubMed  Google Scholar 

  40. Maratt JD et al (2016) No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty 31(9 Suppl):127–130

    Article  PubMed  Google Scholar 

  41. Sheth D et al (2015) Anterior and anterolateral approaches for THA Are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res 473(11):3401–3408

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bensen AS, Jakobsen T, Krarup N (2014) Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. Int Orthop 38(6):1241–1245

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jobory A et al (2021) Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register. Acta Orthop 92(4):413–418

    Article  PubMed  PubMed Central  Google Scholar 

  44. Keene GS, Parker MJ (1993) Hemiarthroplasty of the hip–the anterior or posterior approach? A comparison of surgical approaches. Injury 24(9):611–613

    Article  CAS  PubMed  Google Scholar 

  45. Blewitt N, Mortimore S (1992) Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury 23(5):320–322

    Article  CAS  PubMed  Google Scholar 

  46. Ko CK, Law SW, Chiu KH (2001) Enhanced soft tissue repair using locking loop stitch after posterior approach for hip hemiarthroplasty. J Arthroplasty 16(2):207–211

    Article  CAS  PubMed  Google Scholar 

  47. Thakore RV et al (2015) Operative intervention for geriatric hip fracture: does type of surgery affect hospital length of stay? Am J Orthop (Belle Mead NJ) 44(5):228–232

    PubMed  Google Scholar 

  48. Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105

    Article  PubMed  Google Scholar 

  49. White RH, Zhou H, Romano PS (1998) Length of hospital stay for treatment of deep venous thrombosis and the incidence of recurrent thromboembolism. Arch Intern Med 158(9):1005–1010

    Article  CAS  PubMed  Google Scholar 

  50. Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31(Suppl 4):S131–S138

    Article  PubMed  Google Scholar 

  51. Kucukdurmaz F, Sukeik M, Parvizi J (2019) A meta-analysis comparing the direct anterior with other approaches in primary total hip arthroplasty. Surgeon 17(5):291–299

    Article  PubMed  Google Scholar 

  52. Siu AL et al (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 166(7):766–771

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kumar P et al (2019) Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis. Eur J Orthop Surg Traumatol 29(4):731–746

    Article  PubMed  Google Scholar 

  54. Li N et al (2020) Cemented versus uncemented hemi-arthroplasty for femoral neck fractures in elderly patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 99(8):e19039

    Article  PubMed  Google Scholar 

  55. Khan MA et al (2013) Predictors of early mortality after hip fracture surgery. Int Orthop 37(11):2119–2124

    Article  PubMed  PubMed Central  Google Scholar 

  56. Talsnes O et al (2011) Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 35(6):903–907

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Marc A. Manzo, Kalter Hali & Robert Koucheki

  2. Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Jesse I. Wolfstadt & Johnathan R. Lex

  3. Granovsky Gluskin Division of Orthopaedics, Sinai Health, Toronto, ON, Canada

    Jesse I. Wolfstadt

  4. MSk Lab, Imperial College London, London, UK

    Thomas C. Edwards

Authors
  1. Marc A. Manzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kalter Hali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Koucheki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jesse I. Wolfstadt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas C. Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johnathan R. Lex
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc A. Manzo.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 632 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manzo, M.A., Hali, K., Koucheki, R. et al. Complications and early recovery following hip hemiarthroplasty through the direct anterior approach: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33, 3267–3286 (2023). https://doi.org/10.1007/s00590-023-03603-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03603-0

Keywords

Search

Navigation