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The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures

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Abstract

Purpose

Hip replacement is the most common treatment for displaced femoral neck fractures in the elderly, and minimally invasive surgery is popular in the field of orthopaedic surgery. This study evaluated the outcome of monopolar hemiarthroplasty by the direct anterior approach over a postoperative period up to 2.5 years.

Methods

A total of 86 patients with displaced femoral neck fractures were included (mean age of 86.5 years). Surviving patients were reviewed three months (retrospectively) and one to 2.5 years (prospectively) after surgery. One-year mortality was 36 %.

Results

For all stems, implant positioning with respect to stem alignment, restoration of leg length and femoral offset was correct. Acetabular protrusion was observed in 55 % of the patients one to 2.5 years postoperatively. Subsidence and intraoperative periprosthetic fractures occurred in three patients (3 %) each. All revision stems for postoperative periprosthetic fractures could be implanted using the initial surgical technique without extension of the previous approach. The mean Harris hip score was 85 points at the one to 2.5-year follow-up; 85 % of the patients were satisfied with their hip and 57 % returned to their preoperative level of mobility.

Conclusion

Based on these findings, hemiarthroplasty for hip fractures can be performed safely and effectively via the direct anterior approach with good functional outcome and high patient satisfaction.

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Acknowledgments

The authors wish to thank Esther Bur and Lisa Brunner, the head secretaries of the Department of Orthopaedics and Traumatology, Bürgerspital Solothurn and their teams for assistance with data collection. In addition, the authors wish to thank AO Clinical Investigation and Documentation for their invaluable support in the analysis and Melissa Wilhelmi, PhD for the copy-editing of this manuscript and helping with its preparation for submission.

Grants

No benefits or funds were received in support of this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland

    Kerstin Schneider, Stefanie-Peggy Kuehnel & Naeder Helmy

  2. AO Clinical Investigation and Documentation, Davos, Switzerland

    Laurent Audigé

Authors
  1. Kerstin Schneider
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  2. Laurent Audigé
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  3. Stefanie-Peggy Kuehnel
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  4. Naeder Helmy
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Correspondence to Kerstin Schneider.

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Schneider, K., Audigé, L., Kuehnel, SP. et al. The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures. International Orthopaedics (SICOT) 36, 1773–1781 (2012). https://doi.org/10.1007/s00264-012-1535-4

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  • DOI: https://doi.org/10.1007/s00264-012-1535-4

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