Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

Renken, Felix; Renken, Svenja; Paech, Andreas; Wenzl, M; Unger, Andreas; Schulz, Arndt P.

doi:10.1186/1471-2474-13-141

Cited by 39 publications

(60 citation statements)

References 48 publications

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“…The literature suggests that some of the reported benefits of the direct anterior approach after elective THA may apply to patients undergoing hemiarthroplasty for acute intracapsular femoral neck fractures. [22][23][24][25] The current study showed that patients undergoing the direct anterior approach were more likely to be discharged on postoperative day 3 or earlier (28%) compared with those undergoing other surgical approaches (6%). No difference in the number of feet ambulated during the first 3 postoperative days was noted between groups.…”

Section: Discussionmentioning

confidence: 60%

“…Therefore, it remains unknown whether the benefits reported with the direct anterior approach to THA for degenerative arthritis can be extrapolated to a frail elderly population undergoing hemiarthroplasty for femoral neck fractures. [22][23][24][25] The current study reported and compared the results of patients with displaced femoral neck fractures undergoing hemiarthroplasty with the direct anterior approach with patients undergoing an alternative surgical approach. The authors hypothesized that patients undergoing the direct anterior approach would have a shorter length of stay, improved ambulation, and a higher rate of return to baseline ambulatory status without an increase in complications related to the surgical approach.…”

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confidence: 99%

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Short-term Outcomes of Femoral Neck Fractures Treated With Hemiarthroplasty Using the Anterior Approach

Trinh¹,

Ferrel²,

Pulley³

et al. 2015

Orthopedics

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The direct anterior approach has recently gained popularity for patients undergoing elective total hip arthroplasty. It is unknown whether the reported benefits of the direct anterior approach to elective total hip arthroplasty can be extrapolated to patients undergoing hemiarthroplasty after femoral neck fracture. A retrospective review of 101 patients was performed to compare the outcomes of patients treated with hemiarthroplasty using the direct anterior approach (group 1) with those of patients undergoing the procedure with the posterior, anterolateral, or lateral approach (group 2). No differences in age, American Society of Anesthesiologists classification, and preinjury ambulatory status were identified between treatment groups. No difference in operative time was found between those undergoing the anterior approach (98.7 minutes) and those undergoing other surgical approaches (96.5 minutes) (P=.76). No difference in either the need for transfusion or the number of blood products transfused was seen (P=.21) postoperatively. Patients undergoing the direct anterior approach were more likely to be discharged by postoperative day 3 (P=.004) despite no difference in the recorded number of feet ambulated in the hospital. At a mean clinical follow-up of 16 weeks, there was no difference in the rate of return to baseline ambulatory status between groups (P=.07). The overall rates of major and minor complications for all patients were 23% and 26%, respectively, with no statistically significant differences between groups. The overall dislocation rate of all patients was found to be 3%. All dislocations were observed in group 2. Larger prospective studies are needed to further define the benefits of the direct anterior approach in this patient population.

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Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 99%

Short-term Outcomes of Femoral Neck Fractures Treated With Hemiarthroplasty Using the Anterior Approach

Trinh¹,

Ferrel²,

Pulley³

et al. 2015

Orthopedics

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“…8,20 Alternative surgical approaches such as the anterolateral and direct anterior approaches preserve the posterior structures of the hip, conferring stability to the joint. 21,22 The advantages of THR as treatment for a femoral neck fracture includes the ability to immediately weight bear, and for it to be the definitive treatment of both the fracture and any future conditions such as osteonecrosis or arthritis. The disadvantages include the possibility of dislocation, the functional limitations imposed by a THR, and the more Anteroposterior radiograph demonstrating a minimally displaced femoral neck fracture.…”

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confidence: 91%

Femoral neck fractures

2014

The Bone & Joint Journal

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Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with IF, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred.

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“…Die Inzidenz für die Gesamtbevölkerung liegt bei etwa 90/100 000 und nimmt ab dem 65. Lebensjahr nahezu exponentiell auf knapp 1000/100 000 zu [7,8]. Zwei Drittel dieser Frakturen betreffen Frauen um das 80.…”

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Frakturendoprothetik bei Schenkelhalsfrakturen

Bula¹,

Bonnaire²

2017

OP-JOURNAL

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Zusammenfassung Weltweit hat die Zahl der H?ftendoprothesenimplantationen in den letzten Jahren stetig zugenommen. Von den 200?000 in Deutschland implantierten H?ftendoprothesen erfolgte bereits jede 4. Versorgung aufgrund einer Fraktur. Aktuell ist die endoprothetische Versorgung die h?ufigste Therapie der Schenkelhalsfraktur in Deutschland 1 mit steigendem Anteil, obwohl es bislang keinen nachgewiesenen Vorteil der TEP-Versorgung gegen?ber der Osteosynthese in Hinblick auf das Outcome gibt 2. Die Frage, mit welcher Art von Prothese die Frakturversorgung erfolgen soll, h?ngt von zahlreichen Faktoren ab und sollte das numerische wie das biologische Alter des Patienten, Dislokationsgrad und Frakturmorphologie sowie Komorbidit?ten und funktionellen Anspruch mit einbeziehen. Bei Patienten bis zum 60. Lebensjahr sollte in der Behandlung unabh?ngig vom Dislokationsgrad der Fraktur immer auf einen Gelenkerhalt abgezielt werden (pathologische Frakturen ausgeschlossen). Aber auch die nicht dislozierten und valgisch impaktierten Schenkelhalsfrakturen k?nnen in allen Altersklassen mit Vorteil gegen?ber der Prothese gelenkerhaltend operiert werden. Bei dislozierten Frakturen profitieren ?ltere und k?rperlich reduzierte Patienten (>?65 Jahre) von einer Totalendoprothese. Umso mehr bei begleitend bestehender Koxarthrose. Hemiprothesen sind in aller Regel den alten multimorbiden Patienten vorbehalten, die hier v.?a. von der k?rzeren OP-Zeit und dem geringeren Blutverlust profitieren. Grunds?tzlich wird ab dem 70.?Lebensjahr die Verwendung zementierter Prothesen empfohlen 3. Bei der Frakturendoprothetik handelt es sich, ebenso wie bei der Osteosynthese, um eine Operation von hoher Dringlichkeit, die zur Reduktion der Mortalit?t und sekund?rer Komplikationen innerhalb von maximal 48 Stunden erfolgen muss 4,?5,?6. Dieser Umstand verdeutlicht, dass der Operateur einer Schenkelhalsfraktur sowohl die Endoprothetik wie auch die Osteosynthese beherrschen sollte.

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Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

Cited by 39 publications

References 48 publications

Short-term Outcomes of Femoral Neck Fractures Treated With Hemiarthroplasty Using the Anterior Approach

Short-term Outcomes of Femoral Neck Fractures Treated With Hemiarthroplasty Using the Anterior Approach

Femoral neck fractures

Frakturendoprothetik bei Schenkelhalsfrakturen

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