Study of functional outcomes of anterolateral approach of bipolar hip hemiarthroplasty for management of fracture neck of femur in elderly patients

Abstract

Introduction: Hip hemiarthroplasty is the standard of care for the management of fracture of the femoral neck in elderly patients. While many approaches have been described each with its own set of advantages and disadvantages, final decision regarding the approach to be used often depends on the operating surgeon. This article discusses the functional outcomes of elderly patients with neck of femur fractures operated with bipolar hemiarthroplasty in a tertiary care centre. Materials and Methods: A prospective interventional study was conducted over a duration of 18 months after getting the approval from the institutional ethics committee at a tertiary care centre, consisting of 30 elderly patients (age >60 years) with neck of femur fractures. After required pre-operative evaluation patients were operated with bipolar hemiarthroplasty for the management of the femoral neck fracture. Intra-operative parameters like blood loss and duration of surgery were noted. Post-operative complications such as suture site infection, dislocation, nerve injury, deep venous thrombosis were studied. The improvement in functional outcome was evaluated comparing the pre-operative Harris Hip Score with that at the time of discharge, at 1 month follow up and six months follow up using standard statistical methods. Results: The average operation lasted 68.97 minutes, and 142.67 ml of blood were lost on average. There were no difficulties throughout the operation. There were three occurrences of wound infection among the postoperative sequelae. The typical length of a hospital stay was 12.07 days, whereas the average length of a bed stay was 3.6 days. The average Harris hip score before surgery was 45. The mean Harris hip score was 66 at the time of discharge, and at one month after surgery, it had increased to 75.60, a statistically significant improvement. The mean Harris hip score was 85.77 at six months following surgery, indicating a successful outcome from the intervention. Statistics showed that the improvement was substantial (p <0.05). Conclusion: Anterolateral approaches can reduce operating trauma, operation time, hospital stay, and bedtime. In turn, this can lower the associated perioperative risk in the treatment of femoral neck fractures in elderly patients undergoing hemiarthroplasty and can be used as an alternative approach for the same.