Hip hemi-arthroplasty for neck of femur fracture:What is the current evidence?

• 作者: Alexander M Wood Greg AJ Robertson
• 来源期刊: 世界骨科杂志
• 学科: 医学
• 关键词: Hemi-arthroplasty Prosthesis Stem Head HIP Femoral Neck FRACTURE Cement
• 年，卷（期）: 2018,（11）
• 页码范围: 235-244
• 页数: 10页
• 分类号: R

摘要

This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews)relating to the use of hip hemi-arthroplasty for neck of femur fractures.Regarding the optimal surgical approach,two recent meta-analyses have found that posterior approaches are associated with:higher rates of dislocation compared to lateral and anterior approaches;and higher rates of re-operation compared to lateral approaches.Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures.Assessing the optimal prosthesis head component,three recent meta-analyses and one Cochrane review have found that while unipolar hemiarthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up(up to 1 year),there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome,complication profile,functional outcome and acetabular erosion rates at longer-term follow-up(2 to 4 years).With bipolar hemi-arthroplasty being the more expensive prosthesis,unipolar hemi-arthroplasty is the recommended option.With regards to the optimal femoral stem insertion technique,three recent metaanalyses and one Cochrane Review have found that,while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties,cemented prostheses have lower rates of implant-related complications(particularly peri-prosthetic femoral fracture)and improved postoperative outcome regarding residual thigh pain and mobility.With no significant difference found between the two techniques for medical complications and mortality,cemented hip hemi-arthroplasty would appear to be the superior technique.On the topic of wound closure,one recent meta-analysis has found that,while staples can result in a quicker closure time,there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures.Therefore,either suture or staple wound closure