Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures

Abstract

Introduction Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases. Material and methods In the present retrospective study geriatric patients with FNF (n = 100) treated either by anterior minimal-invasive surgery (AMIS; n = 50) or lateral conventional surgery (LCS; n = 50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed. Results Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not differ between the two groups. Further, more patients in the AMIS group achieved full weight-bearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No significant differences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively. Conclusions In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients.

Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis

“…A total of 268 studies were found through the electronic search and 3 studies were added follwing cross-referenced research on the bibliography of the examined full-text articles. After a preliminary analysis, a total of 50 studies were included in this systematic review [ 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] ( Table 1 ).…”

“…The DL approach was compared to the AL approach in 3 studies [ 40 , 41 , 57 ], to the DA approach in 8 studies [ 10 , 18 , 39 , 41 , 44 , 46 , 57 , 58 ], and to the PL approach in 18 studies [ 5 , 11 , 20 , 23 , 25 , 26 , 27 , 28 , 34 , 36 , 37 , 40 , 41 , 42 , 45 , 51 , 52 , 57 ]. The AL approach was compared to the DA approach in five studies [ 13 , 41 , 48 , 49 , 57 ], and to the PL approach in nine studies [ 19 , 22 , 24 , 38 , 40 , 41 , 49 , 55 , 57 ].…”

“…Nine studies were randomized control trials [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], six were prospective comparative cohort studies [ 19 , 30 , 31 , 32 , 35 , 37 ], thirty-two were retrospective comparative cohort studies [ 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 33 , 34 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] and three were registry studies [ 5 , 25 , 45 ].…”

“… Cochrane risk-of-bias tool for non-randomized studies (ROBINS-I) [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. …”

“… Forest plot and funnel plot of overall meta-analysis evaluating studies with data about mean operative time in patients treated with: direct lateral approach vs. posterolateral approach ( a ): the figure shows the shortest mean operative time in the posterolateral group; direct anterior approach vs. direct lateral approach ( b ): the figure shows the shortest mean operative time in the direct anterior group. Abbreviations: ES, effect size; 95% CI, 95% confidence interval; W, weight; N, sample size [ 11 , 18 , 25 , 29 , 37 , 39 , 41 , 44 , 46 , 51 , 57 , 58 ]. …”