Abstract
Background
Minimally invasive surgery (MIS) can lead to early recovery, but its postoperative effect is short after total hip arthroplasty for osteoarthritis. Because bipolar hemiarthroplasty (BHA) for femoral neck fractures is preferred for elderly patients, early functional recovery may prevent the rapid progression of disuse atrophy, and an MIS surgical approach may improve subsequent hip joint function.
Methods
MIS-BHA was performed using the direct anterior approach, without muscle or tendon detachment. A total of 83 patients who underwent BHA from April 2007 to February 2009 were assigned to MIS-BHA or conventional BHA. Selection of patients for MIS-BHA was not randomized. Hip joint function was evaluated with the Hospital for Special Surgery (HSS) system at 1 month and 1 year after surgery.
Results
There were no significant differences in age, sex, height, weight, body mass index, time from admission to surgery, or preinjury HSS scores between two groups. HSS scores were higher with MIS-BHA (24.2 vs. 20.2; P = 0.01) at 1 month but were similar 1 year after surgery (29.9 vs. 27.2; P = 0.10).
Conclusions
The effectiveness of MIS-BHA for femoral neck fracture is limited to the early postoperative period. Therefore, MIS-BHA does not appear to be appropriate for treatment of femoral neck fractures.
Similar content being viewed by others
References
Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. J Bone Joint Surg Am 2003;85:1673–1681.
Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomized controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 2007;89:160–165.
Lu-Yao GL, Keller RB, Littenberg, B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. J Bone Joint Surg Am 1994;76:15–25.
Bhandari M, Devereaux PJ, Tornetta P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am 2005;87:2122–2130.
Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop 2009;467:2426–2435.
Gallinaro P, Tabasso G, Negretto R, Elena M, Prever B. Experience with bipolar prosthesis in femoral neck fractures in the elderly and debilitated. Clin Orthop 1990;251:26–30.
LaBell LW, Colwill JC, Swanson A. Bateman bipolar hip arthroplasty for femoral neck fractures: a five- to ten-year follow-up study. Clin Orthop 1990;251:20–25.
Lausten GS, Peter V, Nielsen P. Fracture of the femoral neck treated with a bipolar endoprosthesis. Clin Orthop 1987;218:63–67.
Moshein J, Alter AH, Elconin KB, Adams WW, Isaacson J. Transcervical fractures of the hip treated with the Bateman bipolar prosthesis. Clin Orthop 1990;251:48–53.
Wada M, Imura S, Baba H. Use of osteonics UHR hemiarthroplasty for fractures of the femoral neck. Clin Orthop 1997;338:172–181.
Bertin KC, Rottinger H. Anterolateral mini-incision hip replacement surgery. Clin Orthop 2004;429:248–255.
Inaba Y, Dorr LD, Wan Z, Sirianni L, Boutary M. Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop 2005;441:104–114.
Oinuma K, Christoph E, Saito Y, Shiratsuchi H. Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 2007;3:310–326.
Siguier T, Brumpt B. Mini-incision anterior approach does not increase dislocation rate. Clin Orthop 2004;426:164–173.
Owens WD, Felts JA, Spitznagel ELJ. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–243.
Salvati EA, Wilson PDJ. Long-term results of femoral-head replacement. J Bone Joint Surg Am 1973;55:516–524.
Nicoll EA. The unsolved fracture. J Bone Joint Surg Br 1963;45:239–241.
Davison JNS, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, et al. Treatment for displaced intracapsular fracture of the proximal femur. J Bone Joint Surg Br 2001;83:206–212.
Hudson JI, Kenzora JE, Hebel JR, Gardner JF, Scherlis L, Epstein RS, et al. Eight-year outcome associated with clinical options in the management of femoral neck fractures. Clin Orthop 1998;348:59–66.
Sikorski JM, Barrington R. Internal fixation versus hemiarthroplasty for the displaced subcapital fracture of the femur. J Bone Joint Surg Am 1981;63:357–361.
Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Peterson versus posterior approach. Clin Orthop 2006;453:293–298.
Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A, Krismer M, et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech 2009;24:812–818.
Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, et al. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. J Bone Joint Surg Am 2005;87:701–710.
Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE. Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. J Bone Joint Surg Am 2007;89:1153–1160.
Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior with miniposterior approach. J Arthroplasty 2009;24:698–704.
Yoshimura N, Suzuki T, Hosoi T, Orimo H. Epidemiology of hip fracture in Japan: incidence and risk factors. J Bone Miner Metab 2005;23:78–80.
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 1995;77:1551–1556.
Sierra RJ, Shleck CD, Cabanela ME. Dislocation of bipolar hemiarthroplasty. Clin Orthop 2006;442:230–238.
Author information
Authors and Affiliations
About this article
Cite this article
Tsukada, S., Wakui, M. Minimally invasive intermuscular approach does not improve outcomes in bipolar hemiarthroplasty for femoral neck fracture. J Orthop Sci 15, 753–757 (2010). https://doi.org/10.1007/s00776-010-1541-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-010-1541-6