Surgical approach for acute femoral neck fracture may not affect quality of life
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Key takeaways:
- Quality of life was not significantly affected by the surgical approaches of hemiarthroplasty studied.
- Dislocations and reoperations were more common with the posterolateral vs. direct lateral approach.
Results from a randomized clinical trial showed no association between the surgical approaches for cemented hemiarthroplasty studied and 6-month patient-reported quality of life in patients treated for acute femoral neck fracture.
“The observed mean difference in [Euro-Qol-5D] EQ-5D-5L utility score between [direct lateral approach] DLA and [posterolateral approach] PLA was neither statistically significant nor clinically relevant. In addition, the secondary outcomes in function, pain, mobility and tendency to fall did not differ between the groups,” the researchers wrote in the study. “However, patients in the PLA group had a higher risk of prosthesis dislocation and reoperation due to dislocation, which was statistically significant and also clinically relevant.”
Researchers randomly assigned 555 patients with acute femoral neck fractures to undergo hemiarthroplasty through either the PLA (n = 272) or the DLA (n = 283). The trial was also performed alongside a natural experiment that included 288 patients, of which 172 were in the DLA group and 116 were in the PLA group.
The primary study outcome was health-related quality of life 6 months after surgery determined by the results of the EQ-5D-5L questionnaire. Secondary outcomes included dislocations, fear of falling or falls, activities of daily living, pain and reoperations.
Overall, researchers found the difference in mean EQ-5D-5L utility scores between the DLA group (0.5; 95% CI, 0.45-0.55) vs. the PLA group (0.49; 95% CI, 0.44-0.54) was not statistically significant at 6-month follow-up. In addition, secondary outcomes including function, pain, mobility and tendency to fall were not significantly different between the groups.
However, researchers found a higher risk of dislocation and reoperation in the PLA group compared with the DLA group. This difference was clinically and statistically significant.
“The implications of our results to improve patient care are not straightforward. The increased risk for dislocation and reoperation after PLA without clear benefits of that approach could justify a recommendation for DLA,” researchers wrote in the study.
“Alongside this trial, we conducted an economic evaluation, and we thoroughly quantified physical performance and balance in a subgroup of patients. These additional outcomes will help to weigh a broader spectrum of costs and benefits associated with DLA and PLA to better inform evidence-based decisions on the surgical approach for older patients with hemiarthroplasty after a hip fracture.”
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