Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background

Bipolar hip hemiarthroplasty, which presents few advantages compared to total hip replacement, is often considered the treatment of choice for frail older patients presenting with low physical demands. Reported dislocation rates after hip hemiarthroplasty vary between 1% and 17%. Dislocation represents a serious complication and is associated with increased morbidity and mortality after hip hemiarthroplasty.

Research motivation

Approaches for hip hemiarthroplasty are still debated. When considering elective total hip replacement, the direct anterior approach (DAA) is associated with the lowest dislocation rates. However, because of the difficulties associated with this approach, there are some drawbacks to using this approach for frail older patients for hip fracture surgery.

Research objectives

The aim of this study was to compare the direct anterior and posterior approach (PL) early complication rates in patients who underwent bipolar hemiarthroplasty (BHA) for displaced femoral neck fractures.

Research methods

This is a retrospective, single-center comparative cohort study conducted at a university hospital between March 2008 and December 2018. A total of 280 hips (273 patients) were analyzed, of which 171 hips were operated using the PL and 109 hips were operated using the DAA. All patients underwent preoperative X-rays of the pelvis and the healthy hip for preoperative planning purposes.

Research results

The PL for BHA for femoral neck fractures in the elderly was associated with significantly higher complication rates compared to the DAA, respectively 22.7% vs 7.6% (P = 0.0013). This difference 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 = 0.0015). Dislocation rates were also analyzed according to the surgeon’s experience. The risk ratio for dislocation after BHA through PL by a resident or trainee was 1.20 compared to BHA through PL by a senior surgeon.

Research conclusions

The DAA to BHA for patients with displaced femoral neck fractures is associated with lower dislocation rates compared to the PL. This approach might offer some other advantages, specifically lower risks of dislocation-related morbidity and mortality and possibly an economic advantage over the PL.

Research perspectives

Larger prospective randomized trials are needed in order to confirm the advantages of the DAA for hip fracture surgery.