[Short-stem THA-complications and therapy options].

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Einhaltung ethischer Richtlinien. Interessenkonflikt: K.P. Kutzner ist als medizinischer Berater für die Firma Mathys (Schweiz) tätig. Alle beschriebenen Untersuchungen am Menschen oder an menschlichem Gewebe wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patient/-innen liegt eine Einverständniserklärung vor. 7. Ann Med. 2023 Dec;55(1):1378-1392. doi: 10.1080/07853890.2023.2193424. Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review. Jin Z(1), Wang L(2), Qin J(1), Hu H(3), Wei Q(1). Author information: (1)Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China. (2)Department of Orthopedics, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P. R. China. (3)Department of Spinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China. OBJECTIVE: The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those who received posterolateral approach (PLA) for total hip arthroplasty (THA) in the treatment of femoral neck fractures. METHODS: An electronic search was conducted in databases including PubMed, Embase, Web of Science, the Cochrane Library, and CNKI from their inception to January 2022. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of DAA compared to PLA for the management of total hip arthroplasty (THA) in elderly patients using the dichotomous or continuous method with a random or fixed-effect model. RESULTS: 15 studies involving 1284 patients were included; 640 patients receiving DAA and 644 patients receiving PLA. DAA had a longer surgery duration than PLA [WMD = 9.41, 95% CI (4.64, 14.19), I2=95.5%]; The amount of postoperative drainage [WMD= -3.88, 95% CI (-5.59, -2.17), I2=98.3%], length of incision [WMD= -3.88, 95% CI (-5.59, -2.17), I2=98.3%], blood loss [WMD= -3.88, 95% CI (-5.59, -2.17), I2=98.3%], hospitalization time [WMD= -3.88, 95% CI (-5.59, -2.17), I2=98.3%], and postoperative bedtime [WMD = -5.56,95% CI (-7.11, -4.01), I2=99.0%], were similar between the two groups (p  0.05). CONCLUSIONS: DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients than PLA. However, DAA was found to be associated with a high incidence of lateral femoral cutaneous nerve injury and a low incidence of postoperative dislocation.Key messagesThe present study aims to evaluate the clinical outcomes in elderly patients receiving DAA versus PLA for THA in the treatment of femoral neck fractures by mate-analysis.DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients. No significant difference was observed between the colchicine and comparators in terms of the need for HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively, acetabular anteversion angle, acetabular abduction angle, and complications (wound infection, deep vein thrombosis, and intraoperative fracture). DOI: 10.1080/07853890.2023.2193424 PMCID: PMC10071980