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Hemiarthroplasty through direct anterior approach for hip fracture yields good outcomes
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Hemiarthroplasty performed through the direct anterior approach in the treatment of hip fracture yielded good functional outcomes and patient satisfaction with 2.5 years of follow-up, according to this study from researchers in Switzerland.
Researchers investigated 86 patients with a mean age of 86.5 years who underwent treatment for displaced femoral neck fractures. Outcomes and satisfaction were retrospectively reviewed at 3 months, then prospectively reviewed at 1 year to 2.5 years postoperatively. At the 1-year mark, the authors reported mortality of 36%.
Upon review, the authors wrote in the abstract, implant positioning was found to be correct for all investigated stems. From 1 year to 2.5 years postoperatively, 55% of the patients were displaying acetabular protrusion, with subsidence and intraoperative periprosthetic fractures occurring in three patients each.
Revision stems for those patients who sustained postoperative periprosthetic fractures, according to the study abstract, were implanted via the initial surgical technique, without any need for extension of this approach. Mean Harris hip score was 85 points for the 1- to 2.5-year follow-up, with 85% patient satisfaction and 57% of patients returning to preoperative mobility levels.
“Based on these findings, hemiarthroplasty for hip fractures can be performed safely and effectively via the direct anterior approach with good functional outcome and high patient satisfaction,” the authors wrote.
Perspective
Back to TopPer Kjaersgaard-Andersen, MD
Direct anterior approach (DAA) is gaining much attention among surgeons and clinics performing total hip arthroplasty, mainly due the benefits of preserving muscles and tendons — but also the safer intraoperative judgment of leg length with the patient in a supine position. Therefore, even trauma surgeons may be interested in using this technique when performing hemiarthroplasties on elderly patients with displaced femoral neck fractures. In the present study the Swiss team fund DAA to be safe, with good patient function 2 years after surgery in a very old population. However, they also realized a high number of early and late postoperative periprosthetic fractures, which still calls into question what approach overall is most safe for elderly patients with weakened bone when a hemiarthroplasty is needed.
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Schneider K. International Orthopaedics. 2012. doi: 10.1007/s00264-012-1535-4
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