Abstract
Background
A hip hemiarthroplasty is the treatment of choice for a displaced femoral neck fracture in elderly patients not eligible for total hip arthroplasty. There is continuing debate about the optimal surgical approach for this operation, with the most commonly used approaches being posterior and lateral.
Objective
To compare the outcomes of the posterior and the lateral approaches in patients with a displaced femoral neck fracture treated by hemiarthroplasty.
Method
A retrospective study was carried out in two high-volume teaching hospitals in the Netherlands. Electronic patient records were searched for patient characteristics, the operative approach and adverse outcomes.
Results
A total of 1009 patients with a median age of 86 years were included. The posterior approach was used in 51.1% of patients. There were no differences in surgical site infection and periprosthetic fracture rates. There was a trend towards more dislocations in the posterior approach (2.9% vs. 1.4% with an OR of 2.1, 95% CI 0.8–5.1). An uncemented hemiprosthesis was used in 62.7% of patients. Deep surgical site infections and periprosthetic fractures occurred more often in the uncemented group (OR 2.9 and 7.4, respectively).
Conclusion
No differences in adverse outcomes between both approaches could be shown. This study did confirm the relatively high incidence of post-operative complications in uncemented prostheses. Therefore, the cemented prosthesis should be the treatment of choice, with the approach dependent on surgeon preference and experience.
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References
Abram SG, Murray JB (2015) Outcomes of 807 Thompson hip hemiarthroplasty procedures and the effect of surgical approach on dislocation rates. Injury 46(6):1013–1017
Amlie E, Havelin LI, Furnes O, Baste V, Nordsletten L, Hovik O, Dimmen S (2014) Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1476 patients 1–3 years after surgery. Acta Orthop 85(5):463–469
Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ (2012) Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. Int Orthop 36(11):2219–2223
Blewitt N, Mortimore S (1992) Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury 23(5):320–322
de Jong L, Klem TMAL, Kuijper TM, Roukema GR (2018) The minimally invasive anterolateral approach versus the traditional anterolateral approach (Watson-Jones) for hip hemiarthroplasty after a femoral neck fracture: an analysis of clinical outcomes. Int Orthop 42(8):1943–1948
Dutch guideline for the treatment of femoral neck fractures (2016) https://richtlijnendatabase.nl/richtlijn/proximale_femurfracturen. Accessed 15 Feb 2018
Enocson A, Tidermark J, Tornkvist H, Lapidus LJ (2008) Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop 79(2):211–217
Hongisto MT, Nuotio MS, Luukkaala T, Väistö O, Pihlajamäki HK (2018) Lateral and posterior approaches in hemiarthroplasty. Scand J Surg 107(3):260–268
Jones C, Briffa N, Jacob J, Hargrove R (2017) The dislocated hip hemiarthroplasty: current concepts of etiological factors and management. Open Orthop J 11:1200–1212
Kristensen TB, Vinje T, Havelin LI, Engesæter LB, Gjertsen JE (2017) Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture. Acta Orthop 88(1):29–34
Kunkel ST, Sabatino MJ, Kang R, Jevsevar DS, Moschetti WE (2017) A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol 28(2):217–232
Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res 472(4):1291–1299
Li T, Zhuang Q, Weng X, Zhou L, Bian Y (2013) Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PLoS ONE 8(7):e68903
Moerman S, Mathijssen NMC, Niesten DD, Riedijk R, Rijnberg WJ, Koëter S, Kremers van de Hei K, Tuinebreijer WE, Molenaar TL, Nelissen RGHH, Vochteloo AJH (2017) More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC Musculoskelet Disord 18(1):169
Parker MJ (2015) Lateral versus posterior approach for insertion of hemiarthroplasties for hip fractures: a randomised trial of 216 patients. Injury 46(6):1023–1027
Renken F, Renken S, Paech A, Wenzl M, Unger A, Schulz AP (2012) Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach. BMC Musculoskelet Disord 13:141
Rogmark C, Fenstad AM, Leonardsson O, Engesæter LB, Kärrholm J, Furnes O, Garellick G, Gjertsen JE (2014) Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop 85(1):18–25
Sayed-Noor AS, Hanas A, Sköldenberg OG, Mukka SS (2016) Abductor muscle function and trochanteric tenderness after hemiarthroplasty for femoral neck fracture. J Orthop Trauma 30(6):e194–e200
Svenøy S, Westberg M, Figved W, Valland H, Brun OC, Wangen H, Madsen JE, Frihagen F (2017) Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: early complications in a prospective cohort of 583 patients. Injury 48(7):1565–1569
Ugland TO, Haugeberg Svenningsen S, Ugland SH, Berg ØH, Pripp AH, Nordsletten L (2019) High risk of positive Trendelenburg test after using the direct lateral approach to the hip compared with the anterolateral approach: a single-centre, randomized trial in patients with femoral neck fracture. Bone Joint J 101(7):793–799
Unwin AJ, Thomas M (1994) Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip. Ann R Coll Surg Engl 76(5):327–329
Yli-Kyyny T, Ojanperä J, Venesmaa P, Kettunen J, Miettinen H, Salo J, Kröger H (2013) Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients. Scand J Surg 102(2):124–128
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by E.N. de Vries, T.J. Gardenbroek and H. Ammerlaan. The first draft of the manuscript was written by E.N. de Vries and T.J. Gardenbroek, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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de Vries, E.N., Gardenbroek, T.J., Ammerlaan, H. et al. The optimal approach in hip hemiarthroplasty: a cohort of 1009 patients. Eur J Orthop Surg Traumatol 30, 569–573 (2020). https://doi.org/10.1007/s00590-019-02610-4
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DOI: https://doi.org/10.1007/s00590-019-02610-4