Intervention Review

Surgical approaches for inserting hemiarthroplasty of the hip

  1. Martyn J Parker1,*,
  2. Humayon Pervez2

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 22 JUL 2002

Assessed as up-to-date: 23 MAY 2002

DOI: 10.1002/14651858.CD001707


How to Cite

Parker MJ, Pervez H. Surgical approaches for inserting hemiarthroplasty of the hip. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001707. DOI: 10.1002/14651858.CD001707.

Author Information

  1. 1

    Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough, Cambridgeshire, UK

  2. 2

    Addenbrooke's Cambridge University Hospital NHS Foudation Trust , Department of Orthopaedics, Cambridge, UK

*Martyn J Parker, Orthopaedic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, PE3 6DA, UK. martyn.parker@pbh-tr.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JUL 2002

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The operation of insertion of a hemiarthroplasty to the hip refers to replacement of the femoral head with a prosthesis, whilst retaining the natural acetabulum and acetabular cartilage. The main surgical approaches to the hip for insertion of the prosthesis can be broadly categorised as either 'anterior' via the anterior joint capsule, or 'posterior' through the posterior joint capsule.

Objectives

To evaluate, based on evidence from randomised controlled trials, the effects of different surgical approaches for the insertion of a hemiarthroplasty to the hip has on clinical outcomes.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (up to February 2002). Articles of all languages were considered.

Selection criteria

All randomised controlled trials comparing insertion of a hemiarthroplasty by different surgical approaches.

Data collection and analysis

Both reviewers independently assessed trial quality, using a 10 item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically.

Main results

One randomised trial was identified involving 114 patients. The trial had poor methodology (particularly in susceptibility to selection bias), inadequate follow-up of patients who withdrew, and there was limited reporting of results. Medical complications and mortality from six months to two years appeared greater in the posterior group; this difference in mortality, within the structure of the poor methodology, was statistically significant. No other differences were claimed to be significant.

Authors' conclusions

There is currently insufficient evidence from randomised trials to determine the optimum surgical approach for insertion of a hemiarthroplasty to the hip.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Surgical approaches for inserting hemiarthroplasty of the hip

Arthroplasty (total hip replacement) involves replacing both the socket in the hip and the thigh side of the joint with an artificial joint. Hemiarthroplasty (partial hip replacement) leaves the socket intact, replacing only the thigh side. This is used for some people with hip fractures. Anterior surgery (from the front) might reduce the risk of dislocation and damaging the sciatic nerve for the leg, while posterior surgery (from the back) may reduce operating time and lower the risk of fracture. However, the review of trials did not find enough evidence to show which type of surgery for hemiarthroplasty is best.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

髖關節半關節成形術的外科手術法

髖關節半關節成形術的手術也即是使用人工關節替換股骨頭,但仍保留原本的髖臼和髖臼軟骨。 主要的手術方法可以被廣泛地分類成經由前方關節囊進行的”前開法”,或經由後側關節囊進行的”後開法”。

目標

根據隨機對照試驗的證據來評估不同手術方法在髖關節半關節成形術後所帶來的臨床療效。

搜尋策略

我們搜尋了 the Cochrane Musculoskeletal Injuries Group specialised register (直到2002年2月)。考慮了所有語言的文章。

選擇標準

所有比較不同的半關節成形術的手術方法之隨機對照試驗。

資料收集與分析

兩位文獻回顧者獨立地使用十個項目量表評估試驗品質,並擷取數據。在任何可能的情況下,所收集到的數據會以圖型的方式來表現。

主要結論

一項隨機試驗包括了114位病患參與。這項試驗使用非常差的試驗方法(特別是在選擇偏差值的敏感性上),在追蹤已退出病人的追蹤結果也成效不佳,且回報的結果非常有限。 在使用”後開法“組裡面,手術後六個月到兩年的出現併發症的機會及致死率皆較高;這個致死率上的異同處在統計數上非常地顯著,即使在這架構不完全的試驗方法中。 除此之外,兩者之間沒有其它顯著的不同。

作者結論

目前來說,從隨機試驗中所得到的證據仍然不足以顯示在髖關節中置入關節半成形手術的最佳手術方法為何。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前仍沒有足夠的證據顯示那一個手術方法對部分髖關節置換的患者而言是最好的。關節成形術(全髖關節置換術)包括將髖關節的髖臼處及股骨側使用人工關節替換。 半關節成形術(部分關節置換術)則是將髖臼處原封不動,僅替換股骨側的股骨頭。這被用來治療某些髖骨骨折的病患。 前開法手術(從前方)也許會降低脫臼或損傷腿部坐骨神經的風險。而後開手術法(從後方)則可能可以減短手術時間並降低骨折的風險。 然而,本篇文獻回顧的試驗並未發現足夠的證據來證明何種關節成形術的手術方法是最好的。