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Risk Factors with Multilevel Evidence for Dislocation in Patients with Femoral Neck Fractures After Hip Hemiarthroplasty: A Systematic Review

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Abstract

Background

Hip hemiarthroplasty (HA) is a standard surgical procedure for elderly patients with displaced fracture of the femoral neck, where dislocation is a possible complication. This study is a systematic review on the risk factors of implant dislocation in patients with femoral neck fracture following hip hemiarthroplasty (HA), and evaluates the methodological quality of the included studies.

Methods

Studies on risk factor assessment of dislocation following hip HA were sourced from EMBASE, Ovid, PubMed and ScienceDirect databases. The quality of included studies was evaluated using an improved quality evaluation method combined with a best-evidence synthesis method.

Results

A total of 130,127 patients were involved in 17 observational studies included in this systematic review, with a dislocation rate that ranged between 0.76 and 12.2% (overall incidence was 4–5% by meta-analysis). According to the applied quality evaluation criteria, eight studies were considered to be of high quality, six to be of medium quality, and three to be of low quality. The posterolateral surgical approach was identified as the only risk factor supported by strong evidence, while patients with small acetabular coverage and low postoperative offset were identified as risk factors supported by moderate evidence, and 11 other risk factors were supported by limited evidence.

Conclusion

This systematic review provides some evidence in helping surgeons develop optimal prevention strategies for dislocation following hip HA during the perioperative period based on common risk factors identified in the literature. However, conclusive evidence supporting most of these risk factors is lacking and more methodologically rigorous studies are required to increase the confidence of recommendations.

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Acknowledgements

We greatly thank Xiuxiu Wang from Taiyuan University of Technology for the excellent work of diagram.

Funding

This study was supported by National Natural Science Foundation of China (Grant No. 81802204), Second Hospital of Shanxi Medical University Doctor’s Funds (No. 2017-105), the Natural Science Foundation of Shanxi Province (Grant No. 201801D221117), the Program for the Outstanding Innovative Teams of Higher Learning Institutions of Shanxi (2019L0410). Australian National Health and Medical Research Council (APP1120246)

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Author notes

  1. Bin Wang and Haifeng Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic, Second Hospital of Shanxi Medical University, Taiyuan, China

    Bin Wang, Haifeng Liu, Lei Yan & Bin Zhao

  2. Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, China

    Yuanyuan Zhu

  3. Kolling Institute, University of Sydney, Sydney, NSW, 2006, Australia

    Jiao Jiao Li

Authors
  1. Bin Wang
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  2. Haifeng Liu
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  4. Lei Yan
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Correspondence to Bin Zhao.

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The authors declare that they have no conflict of interest.

Ethical Standard Statement

This study has been performed in accordance with the ethical standards and was approved by the Ethics Committee of the Shanxi Medical University. The Ethical Number was 2018LL036.

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Wang, B., Liu, H., Zhu, Y. et al. Risk Factors with Multilevel Evidence for Dislocation in Patients with Femoral Neck Fractures After Hip Hemiarthroplasty: A Systematic Review. JOIO 54, 795–804 (2020). https://doi.org/10.1007/s43465-020-00177-5

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  • DOI: https://doi.org/10.1007/s43465-020-00177-5

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