Yang Yuhui, Zhang Hong, Dai Qing, Zhang Dapeng, Zhou Zhaohong, Jiang Hai, Peng Yunzhi, Huang Jianhua, Hu Linyong, Sun Qianyue
Second Department of Orthopedics, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou, 341000, People's Republic of China.
Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People's Republic of China.
Clin Interv Aging. 2025 Aug 21;20:1315-1324. doi: 10.2147/CIA.S532656. eCollection 2025.
Dislocation following hemiarthroplasty (HA) for femoral neck fractures in the elderly was a rare but severe complication. Tissue-sparing SuperPATH approach for HA had been described with promising results in terms of function recovery, transfusion and dislocation rate. The aim of the present study was to investigate the clinical outcomes, perioperative complications, and mortality rate through SuperPATH (SP) and posterolateral (PL) approach in geriatric patients with high dislocation risk.
A total of 621 patients from January 2015 to January 2024 were retrospectively reviewed. According to high-dislocated risk, 39 patients through SuperPATH approach and 42 patients through posterolateral approach met the inclusion criteria. All the surgeries were performed by the same hip surgery team. The operation time, surgery incision, intraoperative blood loss and complications were evaluated. The postoperative outcomes, especially dislocation and mortality were assessed at 1-month, 6-month, and 1-year follow-up intervals postoperatively.
Compared with PL group, the surgery incision and blood transfusion rate in SP group was significantly decreased. The early Harris hip score in SP group was significantly higher than that of PL group (t = 7.587, p < 0.001) at 1-week postoperatively, without statistic difference at one month and one year. Totally, the one-year mortality for all patients with high risk of dislocation was 18/81 (22.22%). 8 patients sustained one or more dislocations in PL group, while no patients in the SP group did (OR = 1.235, p = 0.004). The incidence of reoperation was significantly lower in SP group. While there was no significant difference of complication and one-year mortality between groups.
SuperPATH approach for bipolar HA was associated with reducing dislocation and accelerating early hip function recovery in high-risk dislocation population. Once predictors of dislocation risk following HA in the elderly were detected, tissue-sparing invasive approach or constrained THA prosthesis might be considered to avoid evitable complications.
老年股骨颈骨折半髋关节置换术（HA）后脱位是一种罕见但严重的并发症。已描述了保留组织的SuperPATH入路进行HA，在功能恢复、输血和脱位率方面取得了令人满意的结果。本研究的目的是通过SuperPATH（SP）和后外侧（PL）入路，调查高脱位风险老年患者的临床结局、围手术期并发症和死亡率。
回顾性分析2015年1月至2024年1月期间的621例患者。根据高脱位风险，39例采用SuperPATH入路和42例采用后外侧入路的患者符合纳入标准。所有手术均由同一髋关节手术团队进行。评估手术时间、手术切口、术中失血和并发症。术后1个月、6个月和1年随访时评估术后结局，尤其是脱位和死亡率。
与PL组相比，SP组的手术切口和输血率显著降低。术后1周时，SP组的早期Harris髋关节评分显著高于PL组（t = 7.587，p < 0.001），1个月和1年时无统计学差异。总体而言，所有高脱位风险患者的1年死亡率为18/81（22.22%）。PL组有8例患者发生1次或多次脱位，而SP组无患者发生脱位（OR = 1.235，p = 0.004）。SP组再次手术的发生率显著较低。而两组之间并发症和1年死亡率无显著差异。
双极HA的SuperPATH入路与高风险脱位人群中减少脱位和加速早期髋关节功能恢复相关。一旦检测到老年HA后脱位风险的预测因素，可考虑采用保留组织的侵入性入路或限制性全髋关节置换假体，以避免不可避免的并发症。
