Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2021; 12(8): 604-619
Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.604
Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis
Ahmed A Khalifa, Mohamed A Haridy, Ali Fergany
Ahmed A Khalifa, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena 83523, Qina, Egypt
Mohamed A Haridy, Department of Orthopaedic, Ibri Regional Hospital, Ibri 511, Oman
Ali Fergany, Department of Orthopaedic, Assiut University Hospital, Assiut 71515, Egypt
Author contributions: Khalifa AA carried out the study conception and design; Haridy MA and Fergany A carried out data acquisition; Khalifa AA, Haridy MA, and Fergany A carried out interpretation of data; all authors drafted the manuscript and designed the figures and tables; Khalifa AA did the critical revision; all authors discussed the results and commented on the manuscript; All authors read and approved the final manuscript and are responsible for the content and similarity index of the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: We admit that the guidelines of the PRISMA 2009 Statement have been adopted for preparation of the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed A Khalifa, MD, FRCS, MSc, Assistant Professor, Surgeon, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena 83523, Qina, Egypt. ahmed_adel0391@med.svu.edu.eg
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: June 16, 2021
Revised: June 20, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 18, 2021
Processing time: 106 Days and 13.7 Hours
ARTICLE HIGHLIGHTS
Research background

Surgical hip dislocation (SHD) was introduced as a safe approach for managing various hip pathologies. It gained popularity among trauma surgeons as a new approach for the management of femoral head fractures (FHFs). Several studies were published on this subject. However, no systematic reviews were carried pooling these data together to generate stronger evidence of this approach utility.

Research motivation

FHFs are considered as intraarticular fractures. Anatomical reduction and preservation of its vascularity are two mandatory perquisites for obtaining optimum outcomes; SHD was introduced for the management of these fractures with the advantage of preserving femoral head vascularity and providing 360 degree visualization of the femoral head.

Research objectives

We carried out this systematic review and meta-analysis to evaluate the efficacy (functional and radiological outcomes) as well as the safety (complications incidence) of using the SHD approach for management of FHFs, which could help encourage more surgeons to widely adopting this approach in their practice.

Research methods

Four major databases were searched (PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) to collect eligible studies reporting on various outcomes (functional, radiological, and complications) after utilizing SHD as described by Ganz in the management of FHFs. Articles basic, surgical, functional, radiographic, and complications data were collected from the included articles.

Research results

Nine studies were eligible and included in the analysis, forming a total of 129 FHFs with an average follow up of 38.4 mo. The average operative time and blood loss were 123.74 min and 491.89 mL, respectively. Excellent and good functional outcomes were obtained in 85% of the patients, while anatomical fracture reduction could be obtained in 74%. The overall complication rate was 44%; the main reported complications were femoral head avascular necrosis, heterotopic ossification, and osteoarthritis, which occurred at an incidence of 12%, 25%, and 16%, respectively. A unique complication to SHD was trochanteric flip osteotomy nonunion and trochanteric bursitis, which occurred at an incidence of 3.4% and 3.8%, respectively. The issue of surgeon experience and its relation to the results and utilization of this approach is still to be studied.

Research conclusions

We believe that this was the most recent systematic review collecting and reporting the data regarding the efficacy and safety of SHD as an approach for management of FHFs; the results of this systematic review suggest the high safety profile of this approach with acceptable functional outcomes.

Research perspectives

We believe that there is a need for further studies and systematic reviews comparing the SHD approach to conventional approaches (anterior and posterior) in the management of FHFs to prove its safety and efficacy.