Charles T, Bloemers N, Kapanci B, Jayankura M. Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures. World J Orthop 2024; 15(1): 22-29 [PMID: 38293256 DOI: 10.5312/wjo.v15.i1.22]
Corresponding Author of This Article
Tatiana Charles, MD, Surgeon, Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, No. 808 Route De Lennik, Brussels 1070, Belgium. tatiana.charles86@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jan 18, 2024; 15(1): 22-29 Published online Jan 18, 2024. doi: 10.5312/wjo.v15.i1.22
Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures
Tatiana Charles, Nicolas Bloemers, Bilal Kapanci, Marc Jayankura
Tatiana Charles, Nicolas Bloemers, Bilal Kapanci, Marc Jayankura, Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
Author contributions: Jayankura M designed research; Jayankura M, Bloemers N, Kapanci B performed research; Jayankura M and Charles T analyzed data; Charles T drafted the manuscript; Charles T, Jayankura M, Kapanci B and Bloemers N proofread the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
Informed consent statement: All study participants or their closest family members provided informed written consent allowing the collection of personal and medical data prior to study enrolment. The need for informed consent was waived by the Ethics Committee in case of death of the patient or if a patient presented with cognitive impairment without known relatives.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tatiana Charles, MD, Surgeon, Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, No. 808 Route De Lennik, Brussels 1070, Belgium. tatiana.charles86@gmail.com
Received: August 18, 2023 Peer-review started: August 18, 2023 First decision: November 1, 2023 Revised: November 15, 2023 Accepted: December 26, 2023 Article in press: December 26, 2023 Published online: January 18, 2024 Processing time: 150 Days and 20.6 Hours
Abstract
BACKGROUND
Dislocation rates after hemiarthroplasty reportedly vary from 1% to 17%. This serious complication is associated with increased morbidity and mortality rates. Approaches to this surgery are still debated, with no consensus regarding the superiority of any single approach.
AIM
To compare early postoperative complications after implementing the direct anterior and posterior approaches (PL) for hip hemiarthroplasty after femoral neck fractures.
METHODS
This is a comparative, retrospective, single-center cohort study conducted at a university hospital. Between March 2008 and December 2018, 273 patients (a total of 280 hips) underwent bipolar hemiarthroplasties (n = 280) for displaced femoral neck fractures using either the PL (n = 171) or the minimally invasive direct anterior approach (DAA) (n = 109). The choice of approach was related to the surgeons’ practices; the implant types were similar and unrelated to the approach. Dislocation rates and other complications were reviewed after a minimum follow-up of 6 mo.
RESULTS
Both treatment groups had similarly aged patients (mean age: 82 years), sex ratios, patient body mass indexes, and patient comorbidities. Surgical data (surgery delay time, operative time, and blood loss volume) did not differ significantly between the groups. The 30 d mortality rate was higher in the PL group (9.9%) than in the DAA group (3.7%), but the difference was not statistically significant (P = 0.052). Among the one-month survivors, a significantly higher rate of dislocation was observed in the PL group (14/154; 9.1%) than in the DAA group (0/105; 0%) (P = 0.002). Of the 14 patients with dislocation, 8 underwent revision surgery for recurrent instability (posterior group), and one of them had 2 additional procedures due to a deep infection. The rate of other complications (e.g., perioperative and early postoperative periprosthetic fractures and infection-related complications) did not differ significantly between the groups.
CONCLUSION
These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate (< 1%) than the PL.
Core Tip: In this study, the posterior approach (PL) to bipolar hemiarthroplasty for femoral neck fractures was associated with a significantly higher complication rate (22.7%) than the direct anterior approach (DAA); 7.6% (P = 0.0013). This difference in complication rates probably reflects the significant difference in postoperative dislocation rates, as no dislocations were encountered in the DAA group compared to a dislocation rate of 9.1% in the PL group (P value = 0.0015).
