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Comparison of Postoperative Complications Between Trochanter Flip Osteotomy and Kocher–Langenbeck Approaches for the Treatment of Femoral Head Fractures: A Systematic Review and Meta-analysis

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Abstract

Purpose

The study aims to identify the optimal approach for femoral head fracture (FHF) by comparing the postoperative complications and outcome score of the Kocher–Langenbeck posterior approach (KLP) and trochanteric flip osteotomy (TFO) through a systematic review and meta-analysis.

Methods

MEDLINE, Embase and the Cochrane Library were systematically searched for studies published up to 22 January 2023, which compared TFO to the KLP for FHF treatment. The main outcomes of this meta-analysis were the rate of postoperative complications including osteonecrosis of the femoral head (ONFH), heterotopic ossification (HO), and total hip replacement (THR) conversion rate and Thompson–Epstein (T–E) score at the final follow-up.

Results

We included four studies with 57 cases of FHFs; 27 and 30 patients underwent TFO and the KLP, respectively. Following the pooled analysis, HO incidence was significantly higher in TFO than in the KLP (OR = 4.03; 95% CI 1.10–14.81; P = 0.04; I2 = 0%), but there were no differences in other variables, including the incidence of ONFH (OR = 0.41; 95% CI 0.07–2.35; P = 0.32; I2 = 0%), THR conversion rate (OR = 0.82; 95% CI 0.16–4.29; P = 0.81; I2 = 0%), and number of inferior results in the T–E score (OR = 0.49; 95% CI 0.14–1.73; P = 0.27; I2 = 0%).

Conclusions

Amongst the posterior approaches for FHFs, the KLP and TFO did not present significant clinical and radiological differences; hence, the approach can be selected depending on the surgeon’s experience and preference.

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Availability of Data and material

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Author notes

  1. Chul-Ho Kim and Dae Sung Ma are co-first authors and have equally contributed this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Chul-Ho Kim

  2. Department of Thoracic & Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Dongnam-gu, Cheonan, Chungnam, Republic of Korea

    Dae Sung Ma

  3. Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea

    Hyung-Chul Cho

  4. Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, (21565) 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, Republic of Korea

    Yong-Cheol Yoon

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  1. Chul-Ho Kim
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  2. Dae Sung Ma
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Contributions

C-HK, DSM and Y-CY conceived of the presented idea and supervised the findings of this work. C-HK, DSM and H-CC were responsible for data collection and statistical analysis. DSM and H-CC contributed to interpretation of the results. C-HK and DSM took the lead in writing the manuscript. All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Yong-Cheol Yoon.

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Conflict of Interest

Chul-Ho Kim, Dae Sung Ma, Hyung-Chul Cho and Yong-Cheol Yoon declare that they have no conflict of interest.

Ethical Approval

Although the present study involved human participants, ethical approval was not required because all data were based on previously published studies that were analysed anonymously without any potential harm to the participants

Informed Consent

Informed consent from the participants was not required because all data were based on previously published studies that were analysed anonymously without any potential harm to the participants.

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Kim, CH., Ma, D.S., Cho, HC. et al. Comparison of Postoperative Complications Between Trochanter Flip Osteotomy and Kocher–Langenbeck Approaches for the Treatment of Femoral Head Fractures: A Systematic Review and Meta-analysis. JOIO 57, 577–585 (2023). https://doi.org/10.1007/s43465-023-00846-1

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  • DOI: https://doi.org/10.1007/s43465-023-00846-1

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