Displaced Hip Fractures: Approach

Description

In this presentation, Matthew Costa discusses the considerations involved in choosing an approach for arthroplasty in cases of displaced intracapsular hip fractures. Highlighting key questions to consider, he emphasizes the importance of selecting the appropriate type of arthroplasty, such as cemented versus uncemented, and the critical nature of the surgical approach concerning dislocation risks. Costa references recent trials, particularly from Rudi Poolman's team in the Netherlands, which indicate that the posterior approach is associated with a higher rate of dislocation compared to the anterior and anterolateral approaches. He expresses a strong preference for the anterolateral approach due to the compelling evidence showing its safety and efficacy, especially in traumatic cases compared to elective surgeries for arthritis.



Costa draws on data from the WHiTE cohort trials, demonstrating significant risks related to dislocations in hemiarthroplasties, including increased mortality rates, prolonged hospital stays, and a permanent decline in the quality of life for patients who experience dislocations. He firmly states that the ramifications of dislocation in these patients are severe, comparing the outcomes to those of patients suffering strokes. By elaborating on the statistics and clinical outcomes, Costa advocates for the anterolateral approach as a critical intervention strategy to minimize dislocation risks and improve patient outcomes.

DOI: 10.1302/3114-251099

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