Choice of Approach in Hemiarthroplasty For Intertrochanteric Femur Fractures: Anterolateral or Posterolateral?

Yıl 2022, , 15 - 20, 22.04.2022

Mehmet Yetiş , Gökay Eken , Mustafa Özçamdallı

https://doi.org/10.46332/aemj.944811

Öz

Purpose: Both anterolateral and posterolateral approaches are commonly chosen for hemiarthroplasty in hip fractures. The superiority of these approaches to each other is not well understood. In this study, we aimed to compare the outcomes of posterolateral and anterolateral approaches in hip hemiarthroplasty for intertrochanteric hip fractures.
Materials and Methods: 79 patients who had AO type 31-A1, 31-A2 and 31-A3 fractures were divided into two groups: 38 patients in group I underwent anterolateral approach, and 41 patients in group II underwent posterolateral approach. Demographic findings, intraoperative blood loss, operation duration, hospital stay duration, blood transfusion amount, intraoperative and postoperative complications, postoperative mobilization time, preoperative and postoperative serum hemoglobin values, Harris Hip Score, and Likert pain scales were all assessed.
Results: There was no significant difference between the groups in terms of age, gender, BMI and AO fracture types, respectively (p=0.356, p=0.981, p=0.343, p=0.631). The mean intraoperative blood loss amount in Group I and II were 413.15 ml (SD±96.34) and 475.60 ml (SD±117.32), respectively (p=0.012). Compatible with this result, the mean postoperative blood transfusion unit in Group I and II were 0.94 units (SD±0.86) and 1.95 unit (SD±1.02), respectively (p<0.001). HHS and Likert scores following both techniques were statistically similar between both groups (p=0.567, p=0.388, respectively).
Conclusion: Our results show that hemiarthroplasty with both anterolateral and posterolateral approaches are viable treatments for intertrochanteric femur fractures, yielding similar clinical outcomes and complication rates. Less intraoperative blood loss and postoperative transfusion rates make the anterolateral approach more favorable compared to the posterolateral approach.

Anahtar Kelimeler

hemiarthroplasty, intertrochanteric femur fracture, anterolateral, posterolateral, approach

Destekleyen Kurum

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Proje Numarası

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İntertrokanterik Femur Kırıkları Tedavisinde Hemiartroplastide Yaklaşım Seçimi: Anterolateral ya da Posterolateral?

Öz

Amaç: Kalça kırıklarında hemiartroplasti uygulanırken hem anterolateral hem de posterolateral sık tercih edilen yaklaşımlardandır. Bu yaklaşımların birbirlerine üstünlükleri tam olarak anlaşılabilmiş değildir. Bu çalışmada intertrokanterik femur kırığı olan hastalara hemiartroplasti uygulamasında anterolateral ve posterolateral yaklaşımları karşılaştırmayı amaçladık.
Araçlar ve Yöntem: AO tip 31-A1, A2 ve A3 proksimal femur kırığı olan 79 hasta iki gruba ayrıldı. Grup 1’deki 38 hastaya anterolateral yaklaşım ile, grup 2’deki 41 hastaya posterolateral yaklaşım ile hemiartroplasti uygulandı. Demografik bulgular, ameliyat sırasındaki kan kaybı miktarı, ameliyat süresi, hastanede yatış süresi, ameliyat sonrası kan replasman miktarı, ameliyat sırası ve sonrası komplikasyonlar, ameliyat sonrası mobilizasyon süresi, ameliyat öncesi ve sonrası serum hemoglobin değerleri, Harris kalça skoru (HKS) ve Likert ağrı skoru değerlendirildi.
Bulgular: Yaş, cinsiyet, vücut kitle indeksi ve kırık tiplerinde grupları arası anlamlı fark saptanmadı (p=0.356, p=0.981, p=0.343, p=0.631). Ortalama ameliyat sırasında kan kaybı 1. grupta 413.15 ml iken 2. grupta 475.60 ml idi (p=0.012). Benzer şekilde ameliyat sonrası ortalama kan transfüzyon miktarı 1. grupta 0.94 ünite iken, 2. grupta 1.95 üniteydi (p<0.001). HKS ve likert ağrı skorları son kontrolde her iki grupta benzerdi (p=0.567, p=0.388).
Sonuç: İntertrokanterik kalça kırıklarında anterolateral ve posterolateral yaklaşım benzer ve kabul edilebilir klinik skorlara sahip yaklaşımlardır. Daha az ameliyat sırası kan kaybı ve ameliyat sonrası transfüzyon miktarı açısından anterolateral yaklaşım daha avantajlı görünmektedir.

Anahtar Kelimeler

hemiartroplasti, intertrokanterik femur kırığı, anterolateral, posterolateral, yaklaşım

Proje Numarası

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Kaynakça

• 1. Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg Br. 1979;61(2):144-147.
• 2. Palan J, Beard DJ, Murray DW, Andrew JG, Nolan J. Which approach for total hip arthroplasty: Anterolateral or posterior? Clin Orthop Relat Res. 2009;467(2):473-477.
• 3. Gibson A. Posterior exposure of the hip joint. J Bone Joint Surg Br. 1950;32(2):183-186.
• 4. Klasan A, Neri T, Oberkircher L, Malcherczyk D, Heyse TJ, Bliemel C. Complications after direct anterior versus Watson-Jones approach in total hip arthroplasty: results from a matched pair analysis on 1408 patients. BMC Musculoskelet Disord. 2019;20(77):1-7.
• 5. Weber M, Hempfing A, Orler R, Ganz R. Femoral revision using the wagner stem: Results at 2-9 years. Int Orthop. 2002;26(1):36-39.
• 6. Bauer R, Kerschbaumer F, Poisel S, Oberthaler W. The transgluteal approach to the hip joint. Arch Orthop Trauma Surg. 1979;95(1-2):47-49.
• 7. Harris WH. A new lateral approach to the hip joint. J Bone Joint Surg Am. 1967;49(5):891-898.
• 8. Muller ME. Total hip prostheses. Clin Orthop Relat Res. 1970;72:46-68.
• 9. Mehlman CT, Meiss L, DiPasquale TG. Hyphenated-history: The kocher-langenbeck surgical approach. J Orthop Trauma. 2000;14(1):60-64.
• 10. Roberts JM, Fu FH, McClain EJ, Ferguson AB, Jr. A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop Relat Res. 1984;187:205-210.
• 11. Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: A systematic review and meta-analysis (prisma). Medicine (Baltimore). 2015;94(50):e2126.
• 12. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(1):1-170.
• 13. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737-755.
• 14. Ham OK, Kang Y, Teng H, Lee Y, Im EO. Consistency and accuracy of multiple pain scales measured in cancer patients from multiple ethnic groups. Cancer Nurs. 2015;38(4):305-311.
• 15. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64(1):17-19.
• 16. Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010;25(5):671-679.
• 17. Bhise S BS, Desai S, Kanode N. Comparative study of patients who underwent hemiarthroplasty of hip by anterolateral and posterolateral approach. Int J Sci Stud. 2018;6(2):36-38.
• 18. Kiyama T, Naito M, Shinoda T, Maeyama A. Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplasty. 2010;25(1):76-80.
• 19. Hasija R, Kelly JJ, Shah NV, et al. Nerve injuries associated with total hip arthroplasty. J Clin Orthop Trauma. 2018;9(1):81-86.
• 20. Khan T, Knowles D. Damage to the superior gluteal nerve during the direct lateral approach to the hip: A cadaveric study. J Arthroplasty. 2007;22(8):1198-1200.
• 21. Wroblewski A, Hoffman D, Miller ET. Direct anterior approach for hip hemiarthroplasty. J Orthop Trauma. 2019;33(1):17-18.