gms | German Medical Science

Objectives: The dislocation of hip prostheses is multifactorial and influences quality of life of geriatric patients. We analysed the correlation between surgical approach and dislocation of primary total hip arthroplasties (THA) in geriatric patients.

Methods: The bibliographic search was conducted in MEDLINE and Cochrane Library (last search: May 2017). We collected studies in English on primary THA in patients whose mean age was at least 65 years. Dysplasia, hip neoplasia, double mobility implants were the main reasons for exclusion. Anatomic differences between approaches are unclearly described in literature which makes a comparative analysis difficult. Therefore we grouped surgical approaches into three categories: anterior, lateral and posterior approach group, based on the criteria of anatomical location and atraumatic or traumatic techniques toward the muscle. Two reviewers selected the studies, evaluated their methodology and retrieved data independently.

Results and conclusion: Of 672 titles found, only 10 met the inclusion criteria, 2 case series and 8 cohort studies. After THA in geriatric patients the overall dislocation rate independently from the surgical approach is 2.39%. The anterior approach group had the lowest dislocation rate (0.5%), followed by the lateral approach group (1.5%) and posterior (4.5%).

We found that the anterior and lateral approach group offer to geriatric patients the advantage of a lower rate of dislocation compared to the posterior approach group. Further research is required to evaluate the interplay among risk factors for dislocation in the geriatric population, such as surgical indication and other types of implants.