Department of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 64239, Israel,
Arch Orthop Trauma Surg. 2013 Nov;133(11):1595-600. doi: 10.1007/s00402-013-1828-0. Epub 2013 Aug 4.
Hip arthroplasty is one of the most common and successful surgical procedures worldwide. Component design and materials as well as surgical techniques constantly evolve. There is no consensus among surgeons regarding the ideal surgical approach and method of fixation.
292 orthopedic surgeons of 10 subspecialties from 57 countries were surveyed on their choice of surgical approach and prosthesis fixation in hip arthroplasty. Their preferences were analyzed according to country of origin, field of expertise and seniority, and compared to current publications.
The response rate was 95-98 %. Surgeons were split between the posterior approach (45 %) and the direct lateral approach (42 %) followed by the anterior approach (10 %) or other (3 %). North American surgeons favored the posterior approach more often than Europeans (69 % compared to 36 %, P < 0.0001) and surgeons from other countries (69 % compared to 45 %, P = 0.01). Sixty-eight percent of all surgeons routinely used noncemented hip prosthesis while 16 % use cemented and 16 % hybrid fixation. Noncemented fixation was preferred among surgeons from Europe and North America compared to other countries (73 % compared to 55 %, P < 0.05). There were no significant differences based on subspecialty, seniority or the number of years of experience.
The most common surgical approaches in use in hip arthroplasty are posterior and lateral. Anterior approach is used by a minority of orthopedic surgeons for that purpose. Cementing hip prosthesis is falling out of favor among orthopedic surgeons worldwide. The trend toward un-cemented hip arthroplasty is not well supported in the current literature.
髋关节置换术是全球最常见和最成功的手术之一。组件设计和材料以及手术技术不断发展。对于理想的手术入路和固定方法，外科医生之间没有共识。
对来自 57 个国家的 10 个亚专科的 292 名骨科医生进行了髋关节置换术中手术入路和假体固定选择的调查。根据原籍国、专业领域和资历对他们的偏好进行了分析，并与当前的出版物进行了比较。
应答率为 95-98%。外科医生分为后路（45%）和直接外侧入路（42%），其次是前路（10%）或其他（3%）。北美外科医生比欧洲人（69%比 36%，P<0.0001）和其他国家的外科医生（69%比 45%，P=0.01）更倾向于后路。所有外科医生中，68%常规使用非骨水泥髋关节假体，16%使用骨水泥，16%使用混合固定。与其他国家相比，欧洲和北美的外科医生更喜欢非骨水泥固定（73%比 55%，P<0.05）。根据亚专科、资历或经验年限，没有显著差异。
髋关节置换术中最常用的手术入路是后路和外侧入路。前路仅被少数骨科医生用于该目的。全球骨科医生对骨水泥髋关节假体的使用不再青睐。目前文献中对非骨水泥髋关节置换术的趋势支持不足。
