Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients

Background With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in media...

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Published in:BMC musculoskeletal disorders 2023-10, Vol.24 (1), p.1-776, Article 776
Main Authors: Di Martino, Alberto, Pederiva, Davide, Brunello, Matteo, Tassinari, Leonardo, Geraci, Giuseppe, Stefanini, Niccolò, Faldini, Cesare
Format: Article
Language:English
Subjects:
Aging
Blood transfusion
Blood transfusions
Care and treatment
Comparative analysis
Direct anterior approach
Femur
Fractures
Geriatrics
Hip
Hospitals
Infections
Injuries
Medical research
Medicine, Experimental
Musculoskeletal diseases
Patient outcomes
Patients
Posterolateral approach
Proximal femur fractures
Recovery of function
Statistical analysis
Surgeons
Surgery
Surgical outcomes
Total hip arthroplasty
Transplants & implants
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Summary:Background With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery. Methods A total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77). Results Group A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041). Conclusion The use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population. Keywords: Total hip arthroplasty, Proximal femur fractures, Direct anterior approach, Posterolateral approach
ISSN:1471-2474
1471-2474
DOI:10.1186/s12891-023-06919-4