Risk Factors with Multilevel Evidence for Dislocation in Patients with Femoral Neck Fractures After Hip Hemiarthroplasty
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ORIGINAL ARTICLE
Risk Factors with Multilevel Evidence for Dislocation in Patients with Femoral Neck Fractures After Hip Hemiarthroplasty: A Systematic Review Bin Wang1 · Haifeng Liu1 · Yuanyuan Zhu2 · Lei Yan1 · Jiao Jiao Li3 · Bin Zhao1 Received: 11 March 2020 / Accepted: 15 June 2020 © Indian Orthopaedics Association 2020
Abstract Background Hip hemiarthroplasty (HA) is a standard surgical procedure for elderly patients with displaced fracture of the femoral neck, where dislocation is a possible complication. This study is a systematic review on the risk factors of implant dislocation in patients with femoral neck fracture following hip hemiarthroplasty (HA), and evaluates the methodological quality of the included studies. Methods Studies on risk factor assessment of dislocation following hip HA were sourced from EMBASE, Ovid, PubMed and ScienceDirect databases. The quality of included studies was evaluated using an improved quality evaluation method combined with a best-evidence synthesis method. Results A total of 130,127 patients were involved in 17 observational studies included in this systematic review, with a dislocation rate that ranged between 0.76 and 12.2% (overall incidence was 4–5% by meta-analysis). According to the applied quality evaluation criteria, eight studies were considered to be of high quality, six to be of medium quality, and three to be of low quality. The posterolateral surgical approach was identified as the only risk factor supported by strong evidence, while patients with small acetabular coverage and low postoperative offset were identified as risk factors supported by moderate evidence, and 11 other risk factors were supported by limited evidence. Conclusion This systematic review provides some evidence in helping surgeons develop optimal prevention strategies for dislocation following hip HA during the perioperative period based on common risk factors identified in the literature. However, conclusive evidence supporting most of these risk factors is lacking and more methodologically rigorous studies are required to increase the confidence of recommendations. Keywords Hip hemiarthroplasty · Dislocation · Risk factor · systematic review
Introduction Bin Wang and Haifeng Liu contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43465-020-00177-5) contains supplementary material, which is available to authorized users. * Bin Zhao [email protected] 1
Department of Orthopedic, Second Hospital of Shanxi Medical University, Taiyuan, China
2
Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, China
3
Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia
Hip hemiarthroplasty (HA) is the standard surgical procedure for the vast majority of elderly patients with displaced fracture of the femoral neck due to its relatively short operating time and prompt recovery [1, 2]. It was first introduced in 1940 by Moore and Bolhman, and the Austin-Moore endo
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