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Journal of Orthopaedics and Traumatology

Hip surgery from the front not linked to fewer deaths

One-year death rates were 26% with surgery from the front, versus 26%, 26% and 27% with three other approaches.

Paper by Tijs J. M. de Koningh, Thomas P. Bosch, Rudolf Wilhelm Poolman, Maaike G. J. Gademan, Pieter Bas de Witte · Leiden University Medical Center
Figure 1. Inclusion flow chart.
Open the figure at full size
Figure 1. Inclusion flow chart.Inclusion flow chart.de Koningh et al.

Our read

Interventions
Studied:
Cohort study of 40,981 people (1 year)
In the record:
One of 5 papers on direct anterior approach on record: 5 with results in people.

Editor of record: Boris Djordjevic · AgingResearch.News

Paper
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Among 40,981 Dutch patients aged 75 or older who had partial hip replacement after a hip fracture, a retrospective cohort study emulated a trial comparing surgical approaches. Registry records covered operations from 2007 through 2021. Patients’ average age was 85.1 years, and 67.5% were women.

The researchers matched 21,393 patients on characteristics including age, sex and measures of health to make the groups more comparable. Within one year, 26% died after the direct anterior approach, which reaches the hip from the front. Death rates were 26% for the back-and-side approach, 26% for the side approach and 27% for the front-and-side approach. The analysis found no statistically significant differences in one-year mortality between the front approach and the other three.

Why it matters

Hip fractures pose challenges in later life. This comparison addresses whether potential benefits of operating from the front extend to survival after partial hip replacement.

Caveats

The authors note that registry data captured only part of patients’ health and frailty, so remaining differences could have affected the comparisons. The results do not address younger patients or people having total hip replacement.

Where the evidence stands

Direct anterior approach

Humans: a single group. Cells, worms or flies and mice: nothing yet.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Against: findings that point the other way from most findings on the same outcome.

  • 5 independent labs in 4 countries
  • 1 finding against

Hemiarthroplasty

Humans: replicated by independent labs. Cells, worms or flies and mice: nothing yet.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Against: findings that point the other way from most findings on the same outcome.

  • 19 independent labs in 8 countries
  • 5 findings against
  • Funders: Medical Science and Technology Project of Zhejiang Province and 6 more

From the paper

Participants

Overall, 40,981 eligible patients were included.

Results

Limitation

Although the LROI contains reliable data on all HHA patients from 2007 onwards, errors can still occur, e.g., incomplete data registration, including missing cases (limited generalizability) …

Limitations

Quoted word for word from the full text on link.springer.com.

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