Conjoined tendon preserving posterior approach in hemiarthroplasty for femoral neck fractures: A prospective multicenter clinical study of 322 patients

Abstract

Purpose The posterior approach is widely used in femoral hemiarthroplasty. The major problem with this approach is the high risk of postoperative dislocation. A modified posterior approach, the conjoined tendon preserving posterior approach (CPP), was developed to reduce postoperative dislocations. The objective of this multicenter study was to evaluate the efficacy and safety of hemiarthroplasty performed using the CPP approach for femoral neck fractures. Methods A total of 322 patients with femoral neck fracture, from 10 facilities, were prospectively studied. Bipolar hemiarthroplasty using the CPP approach was performed, using the same type of implants. Hip joint movement was not restricted following surgery, regardless of a patient’s cognitive status. Final follow-up was performed 9.1 ± 1.5 months after surgery. Results Hemiarthroplasty was undertaken in 320 patients using the CPP approach. The mean age, operative time, and intraoperative blood loss were 83.3 ± 7.4 years, 70.0 ± 22.7 min, and 134.8 ± 107.9 mL, respectively. No postoperative dislocations were observed during the study period. Intraoperative adverse events related to the hip joint included femoral fractures in five patients (1.6%) and trochanteric fractures in four patients (1.3%). Postoperative hip joint adverse events included a periprosthetic fracture in one patient (0.3%), deep infection in two patients (0.6%), and stem subsidence in one patient (0.3%). Postoperative deaths occurred in 23 patients (7.2%). One patient (0.3%) had a severe non-hip adverse event unrelated to surgery that prevented independent living, while five patients (1.6%) had a moderate non-hip adverse event that required treatment. Conclusion The CPP approach prevented postoperative dislocation following femoral hemiarthroplasty in elderly patients, with no CPP-associated specific adverse events.

Clinical Outcomes of Total Hip Arthroplasty With the Anterolateral Modified Watson-Jones Approach for Displaced Femoral Neck Fractures

“…Of these, there were 8 cases of postoperative dislocation, with a dislocation rate of 2.7%. 26 Although THA for FNF is known to have a higher dislocation rate than HA, 7 - 9 , 14 the dislocation rate in our study was lower than that in our HA via the posterior approach.…”

Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures

“…The conjoined tendon-preserving posterior (CPP) approach in BHA for femoral neck fractures has been reported to address postoperative dislocation by Nakamura et al [ 15 ]. The CPP approach is a modified conventional posterior approach, which preserves the piriformis muscles and the conjoined tendon composed of the superior gemellus, internal obturator, and inferior gemellus muscles, as well as the joint capsule covered by the conjoined tendon [ 15 , 16 ]. The minimally invasive external rotation preserving procedure, which preserves muscles ranging from the piriformis to the internal obturator, was used.…”

“…The minimally invasive external rotation preserving procedure, which preserves muscles ranging from the piriformis to the internal obturator, was used. However, postoperative dislocation occurred in their institute [ 14 , 15 ]. They thought it preserves the areas of the short external rotator muscles and capsular ligament through caudal expansion in order to achieve increased joint stability and prevent dislocation [ 15 ].…”

A comparison of different surgical approaches to hemiarthroplasty for the femoral neck fractures: A meta-analysis

“…There are various approaches to hemiarthroplasty, such as the direct anterior approach (DAA) (7), the lateral approach (8), and the true posterior approach (9). Different approaches impact the patient's early postoperative mobility and the occurrence of complications (10).…”