Fullam James, Theodosi Paraskevas G, Charity John, Goodwin Victoria A
NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Room 2.26, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
Department of Trauma and Orthopaedics, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK.
BMC Surg. 2019 Mar 8;19(1):32. doi: 10.1186/s12893-019-0493-9.
Hemiarthroplasty for hip fracture is a common surgical procedure. A number of distinct approaches are used to access the hip joint. The most commonly used are the direct lateral approach (DLA), and the posterior approach (PA). Internationally there is little consensus on which of these approaches to use. Current guidance is based on a limited selection of evidence and choice of approach is frequently based on surgeon preference. Historically, recommendations have been made based on dislocation rates. In light of technical advancements and greater recognition of patient priorities, outcomes such as post-operative function and pain may be considered more important in the modern context. The aim of this scoping review was to summarise the literature pertaining to the comparison of common surgical approaches to the hip for hemiarthroplasty.
A scoping review methodology was used to examine the range and nature of primary research. Using systematic methods we searched for studies that directly compared the DLA and PA. Studies reporting the following outcomes were considered; dislocation, mortality, pain, activities of daily living, functionality, health-related quality of life, length of stay, surgeon assessment of difficulty, and adverse events. MEDLINE, EMBASE and The Cochrane Library were searched. Relevant information was extracted and synthesis of the retrieved data followed a basic content analytical approach.
A total of 13 studies were retrieved: 12 observational studies and 1 randomised trial. The majority of studies were based at single sites. Larger observational studies using multi-site and national registry data have emerged in recent years. Reporting of technique and outcomes is inconsistent. A trend for higher rates of dislocation using the PA was observed and eight studies recommended the use of the DLA over the PA.
This scoping review demonstrates that the existing evidence is highly heterogeneous in nature and not of a sufficient quality to inform practice recommendations. This issue would be best addressed by additional RCTs, and high quality national-level observational data. Standardisation of the recording of patient risk factors, surgical and post-operative intervention protocols, and outcomes in all study designs would strengthen the potential for valid comparison of future findings.
髋部骨折半髋关节置换术是一种常见的外科手术。有多种不同的入路用于显露髋关节。最常用的是直接外侧入路（DLA）和后入路（PA）。在国际上，对于使用哪种入路几乎没有共识。当前的指南基于有限的证据选择，入路的选择通常基于外科医生的偏好。从历史上看，建议是基于脱位率做出的。鉴于技术进步以及对患者优先事项的更多认识，在现代背景下，诸如术后功能和疼痛等结果可能被认为更为重要。本范围综述的目的是总结有关髋部半髋关节置换术常见手术入路比较的文献。
采用范围综述方法来检查原始研究的范围和性质。我们使用系统方法搜索直接比较DLA和PA的研究。考虑报告以下结果的研究：脱位、死亡率、疼痛、日常生活活动、功能、健康相关生活质量、住院时间、外科医生对手术难度的评估以及不良事件。检索了MEDLINE、EMBASE和Cochrane图书馆。提取相关信息，并采用基本的内容分析方法对检索到的数据进行综合。
共检索到13项研究：12项观察性研究和1项随机试验。大多数研究基于单一地点。近年来出现了使用多地点和国家登记数据的更大规模的观察性研究。技术和结果的报告不一致。观察到使用PA脱位率较高的趋势，八项研究推荐使用DLA而非PA。
本范围综述表明，现有证据在性质上高度异质性，质量不足以提供实践建议。这个问题最好通过额外的随机对照试验和高质量的国家级观察数据来解决。在所有研究设计中对患者风险因素、手术和术后干预方案以及结果的记录进行标准化，将增强未来研究结果进行有效比较的可能性。
