Background The aim of this study was to determine if it was feasible and safe to perform total hip arthroplasty (THA) using the direct anterior approach (DAA) when compared with the conventional posterolateral approach (PA) in patients with femoral neck fractures. The time required to start walking was investigated to identify advantages of the muscle-sparing approach. Safety of the approach was judged based on the incidence and nature of all complications. Methods We retrospectively reviewed 67 THA cases due to femoral neck fractures from October 2015 to January 2019. The PA was used in 31 cases, and the DAA was used in 36 cases. The average operative time and amount of bleeding were evaluated. Cup inclination, anteversion, and leg length discrepancy (LLD) were also measured on radiographs. The time to start walking and complications (e.g., intraoperative fracture, infection, and dislocation) were recorded. Results The mean operative time was 84.35 ± 13.95 minutes in PA group and 99.22 ± 20.33 minutes in DAA group ( p = 0.010). But after experiencing 20 cases using the DAA, there was no statistically significant difference in the operative time between the groups. The mean volume of bleeding was 428.73 ± 207.26 mL in the PA group and 482.47 ± 150.14 mL in the DAA group. There was no difference in the acetabular cup position between two groups. Ambulation was started at 3.94 days after surgery on average in the PA group and 3.14 days in the DAA group, showing a statistically significant difference. Intraoperative fracture and infection were not observed in either group. The incidence of LLD was 1 in each group. The dislocation rate was 3.2% (1 case) in the PA group and 5.5% (2 cases) in the DAA group. Conclusions Although the DAA for THA was similar to the PA in terms of operative time, volume of bleeding, and complications, the DAA showed a great advantage in early rehabilitation as a muscle-sparing procedure in the elderly with femoral neck fractures.

To examine the influence of restrictive pulmonary dysfunction on osteoporotic thoracic vertebral fractures. Overview of Literature: Osteoporotic thoracic vertebral fractures generally result in an increased kyphotic angle, which in turn may lead to pulmonary function impairment. Impaired pulmonary function could be associated with vertebral fractures. However, an association between osteoporotic thoracic vertebral fractures and pulmonary function remains controversial. Methods: A total of 96 patients were enrolled in this study, 30 of whom had osteoporotic thoracic vertebral fractures (group 1), 30 with chronic back pain (group 2), and 36 with chronic pulmonary diseases (group 3). Radiologic study of prevalent vertebral fractures, thoracic kyphotic angle, bone mineral density, relaxed expiratory vital capacity, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) in spirometry was investigated. Results: The mean FVC and FEV1 were 75.66%±20.23% and 79.93%±22.48%, respectively, in group 1; 84.50%±16.25% and 91.87%±21.65%, respectively, in group 2; and 91.64%±17.53% and 91.03%±23.71%, respectively, in group 3. Group 1 (patients with osteoporotic thoracic vertebral fracture) had the lowest FVC among the three groups (p=0.01). Group 1 revealed worse result of pulmonary dysfunction than group 3 (patients with chronic pulmonary diseases) (p=0.01). The average kyphosis angle of the thoracic spine was 26.95°±15.17°, 36.47°±20.08°, and 28.58°±10.58° in groups 1, 2, and 3, respectively. There was a negative correlation between thoracic kyphosis and FEV1 (r=−0.309, p=0.01). Conclusions: The results suggest that osteoporotic thoracic vertebral fracture burden could be affected by restrictive pulmonary dysfunction.

Purpose The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3-03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

Purpose: To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. Materials and Methods: A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. Results: The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27。 ; 2 cases were out of safety angle. Mean anteversion was 16.18。. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. Conclusion: DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.

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