Abstract
We compared the 3-month dislocation rate for hip hemiarthroplasties inserted via the posterior and direct lateral routes. In all, 2906 primary hemiarthroplasties, performed between 1986 and 1992 in four hospitals on a training hospital rotation, were analysed. The posterior approach was used in 1656 (57%) and the lateral in 1250 (43%). The groups were otherwise comparable. The overall dislocation rate for the posterior approach was 9.0% (149/1656), whereas that for the direct lateral approach was 3.3% (41/2150). The difference is statistically highly significant. In addition, we analysed the dislocation rate for each approach in the three broad groups of surgical trainee. For senior registrars, there was no statistical difference in the dislocation rate. However, for registrars and senior house officers, there were statistically highly significant differences in the dislocation rate for posterior and direct lateral approaches (8.4% vs 3.3% and 14.2% vs 3.6%, respectively). We conclude that, because of the high mortality associated with dislocation of a hemiarthroplasty, the posterior approach for this operation should now be abandoned, especially by surgical trainees early in their careers.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BOYD H. B., SALVATORE J. E. ACUTE FRACTURE OF THE FEMORAL NECK: INTERNAL FIXATION OR PROSTHESIS? J Bone Joint Surg Am. 1964 Jul;46:1066–1068. [PubMed] [Google Scholar]
- Blewitt N., Mortimore S. Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury. 1992;23(5):320–322. doi: 10.1016/0020-1383(92)90179-v. [DOI] [PubMed] [Google Scholar]
- Chan R. N., Hoskinson J. Thompson prosthesis for fractured neck of femur. A comparison of surgical approaches. J Bone Joint Surg Br. 1975 Nov;57(4):437–443. [PubMed] [Google Scholar]
- Davidson T. I., Bodey W. N. Factors influencing survival following fractures of the upper end of the femur. Injury. 1986 Jan;17(1):12–14. doi: 10.1016/0020-1383(86)90005-7. [DOI] [PubMed] [Google Scholar]
- Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64(1):17–19. doi: 10.1302/0301-620X.64B1.7068713. [DOI] [PubMed] [Google Scholar]
- MOORE A. T. Metal hip joint; a new self-locking vitallium prosthesis. South Med J. 1952 Nov;45(11):1015–1019. doi: 10.1097/00007611-195211000-00001. [DOI] [PubMed] [Google Scholar]
- Paton R. W., Hirst P. Hemiarthroplasty of the hip and dislocation. Injury. 1989 May;20(3):167–169. doi: 10.1016/0020-1383(89)90091-0. [DOI] [PubMed] [Google Scholar]
- THOMPSON F. R. Two and a half years' experience with a vitallium intramedullary hip prosthesis. J Bone Joint Surg Am. 1954 Jun;36-A(3):489–502. [PubMed] [Google Scholar]
- Wood M. R. Femoral head replacement following fracture: an analysis of the surgical approach. Injury. 1980 May;11(4):317–320. doi: 10.1016/0020-1383(80)90104-7. [DOI] [PubMed] [Google Scholar]