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Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study

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Abstract

Background

In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs).

Aim

The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs.

Materials and methods

Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months.

Results

Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant.

Conclusions

The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population.

Level of evidence

Level IV, retrospective cohort study.

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Acknowledgements

We thank Dr. Marta Beauchamp and Dr. Michael Teodori for their work as language editors of this article.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology A, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia

    Mauro Spina & Massimo Balsano

  2. Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia

    Valentina Luppi, Jacopo Chiappi & Francesco Bagnis

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  1. Mauro Spina
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Correspondence to Mauro Spina.

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None of the authors have any financial and personal relationships with other people or organizations that could inappropriately influence their work. All authors declare that they have no conflict of interest.

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Spina, M., Luppi, V., Chiappi, J. et al. Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study. Aging Clin Exp Res 33, 1635–1644 (2021). https://doi.org/10.1007/s40520-020-01696-9

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