Abstract
Background
The minimally invasive direct anterior approach (MDAA) has been reported to be useful in total hip arthroplasty. The benefits of this approach may be useful for the treatment of femoral neck fractures. Aim of this study is to compare MDAA and postero-lateral approach (PLA) in patients treated with hip hemiarthroplasty for femoral neck fractures.
Materials and methods
Between 2013 and 2014, 109 patients underwent bipolar hip hemiarthroplasty for femoral neck fracture: 88 female and 21 male with a mean age of 88 years old. PLA was performed in 54 cases and MDAA in 55 cases.
Results
The mean surgery time was significantly lower in MDAA group (P = 0.001). The hemoglobin loss was significantly lower in MDAA group (P = 0.02). The mean postoperative pain was significantly lower in the MDAA group (P = 0.001). The mean hospitalization period was 2 days lower in the MDAA group but with no significant difference between the two groups (P = 0.09). Hip dislocation was higher in PLA cases (7.4 %) than in MDAA cases (1.8 %). Periprosthetic fracture occurred only in one case of PLA. Great trochanter fracture occurred in 1 MDAA cases, while no cases were observed in the PLA group.
Conclusions
Minimally invasive direct anterior approach for hip hemiarthroplasty in elderly people with femoral neck fracture provided significant benefit in the early postoperative period when compared to the postero-lateral approach in terms of surgery time, hemoglobin loss, postoperative pain, time of recovery and dislocation rate.
Level of evidence
Therapeutic study, level IV (case series).
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References
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
Becker DJ, Kilgore ML, Morrisey MA (2010) The societal burden of osteoporosis. Curr Rheumatol Rep 12(3):186–191
Frerichmann U, Raschke MJ, Stockle U, Wohrmann S, Lohmann R (2007) Proximal femoral fractures in the elderly. Data from health insurance providers on more than 23 million insured persons—part 2. Unfallchirurg 110(7):610–616
Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. Br Med J 331(7529):1374
Giusti A, Barone A, Razzano M, Pizzonia M, Oliveri M, Pioli G (2008) Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: one-year follow-up. Clin Exp Res 20(3):253–259
Murphy SB, Tannast M. (2006) Conventional vs minimally invasive total hip arthroplasty. A prospective study of rehabilitation and complications. Orthopade 35(7):761–764, 766–768
Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12:123–129
Oinuma K, Eingartner C, Saito Y, Shiratsuchi H (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19:310–326
Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 24:698–704
Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ (2003) Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 85-A(Suppl. 4):39–48
Rachbauer F, Krismer M (2008) Minimally invasive total hip arthroplasty via direct anterior approach. Oper Orthop Traumatol 20:239–251
Maffiuletti NA, Impellizzeri FM, Widler K, Bizzini M, Kain MS, Munzinger U, Leunig M (2009) Spatiotemporal parameters of gait after total hip replacement: anterior versus posterior approach. Orthop Clin North Am 40:407–415
Bender B, Nogler M, Hozack WJ (2009) Direct anterior approach for total hip arthroplasty. Orthop Clin North Am 40(3):321–328
Vavken P, Kotz R, Dorotka R (2007) Minimally invasive hip replacement–a metaanalysis. Z Orthop Unfall 145(2):152–156
Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE (2007) Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. J Bone Joint Surg Am 89(6):1153–1160
Zawadsky MW, Paulus MC, Murray PJ, Johansen MA (2014) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty 29(6):1256–1260
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Petrie A (2006) Statistics in orthopaedic papers. J Bone Joint Surg Br 88:1121–1136
Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289
Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001
Kaneko K, Ohbayashi A, Okahara H, Iwase H, Kurosawa H (2005) Minimally invasive hemiarthroplasty in femoral neck fractures. Randomized comparison between a mini-incision and an ordinary incision: preliminary results. Eur J Orthop Surg Traumatol 15(1):19–22
Mahmood A, Zafar MS, Majid I, Maffulli N, Thompson J (2007) Minimally invasive hip arthroplasty: a quantitative review of the literature. Br Med Bull 84:37–48
Cheng T, Feng JG, Liu T, Zhang XL (2009) Minimally invasive total hip arthroplasty: a systematic review. Int Orthop 33(6):1473–1481
Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Nöth U (2012) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthopaed (SICOT) 36:491–498
Kampa RJ, Prasthofer A, Lawrence-Watt DJ, Pattison RM (2007) The internervous safe zone for incision of the capsule of the hip. A cadaver study. J Bone Joint Surg Br 89:971–976
Baba T, Shitoto K, Kaneko K (2013) Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 4(2):85–89
Sierra RJ, Schleck CD, Cabanela ME (2006) Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and outcome. Clin Orthop Relat Res 442:230–238
Suh KT, Kim DW, Lee HS, Seong YJ, Lee JS (2012) Is the dislocation rate higher after bipolar hemiarthroplasty in patients with neuromuscular diseases? Clin Orthop Relat Res 470(4):1158–1164
Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L (2009) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 467:2426–2435
Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124
Siguier T, Siguier M, Brumpt B (2004) Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements. Clin Orthop Relat Res 426:164–173
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Pala, E., Trono, M., Bitonti, A. et al. Hip hemiarthroplasty for femur neck fractures: minimally invasive direct anterior approach versus postero-lateral approach. Eur J Orthop Surg Traumatol 26, 423–427 (2016). https://doi.org/10.1007/s00590-016-1767-x
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DOI: https://doi.org/10.1007/s00590-016-1767-x