Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Abstract

Purpose Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. Methods We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia® stem with selfcentring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test.Results After a dorsal approach 10.5 % [confidence interval (CI) 7.7-13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7-13.6 %), which was not significantly different (p00.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2-5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0-1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5-8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2-2.2 %). The frequency of the other types of complications did not significantly differ. Conclusions The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…In a recently pub- lished randomized, controlled trial involving 216 patients with hip fractures treated with HA, performed either with a lateral or a posterior approach, no differences could be found regarding residual pain or regain of walking ability . Biber et al (2012) conducted a retrospective study on 704 patients in 2012 and concluded that there was no difference between the posterior approach and the direct lateral approach regarding early surgical complications. However, the posterior approach predisposed to dislocation whereas the direct lateral approach predisposed to hematoma.…”

Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture

“…Biber et al. (2012) conducted a retrospective study on 704 patients in 2012 and concluded that there was no difference between the posterior approach and the direct lateral approach regarding early surgical complications. However, the posterior approach predisposed to dislocation whereas the direct lateral approach predisposed to hematoma.…”

On-table decision-making in intracapsular hip fracture surgery: mid-term results of a pilot study

“…The closed reduction manoeuvre routinely uses traction, adduction and internal rotation. If intact, especially the obliquely from inferior lateral to posterior medial running inferior retinaculum of Weitbrecht will assist the reduction manoeuvre in most cases [30,31]. If disrupted, a closed reduction manoeuvre will be difficult to impossible to obtain.…”