Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures

Abstract

Background Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral). Methods A retrospective review identified 52 patients who underwent primary THA for FNF between 2009 and 2018, including 20 via the DA approach and 32 by alternative approaches. All procedures were exclusively performed by high-volume arthroplasty surgeons. Perioperative results, complications, and clinical outcomes were compared with those of routine statistical methods. Mean follow-up duration was 3 years (range, 1-8). Results The average age was 74 years (range, 57-92) with similar baseline characteristics between the 2 groups ( P = .09). The DA cohort demonstrated significantly shorter length of stay (3 days vs 5 days, P < .01) and discharge to home vs skilled nursing facility (40.0% vs 9.4% P = .014). There was a trend toward decreased complications (0% vs 16%, P = .08). There were no dislocations or fractures in either cohort. Final Harris Hip Scores (94 vs 81, P = .07) and return to community ambulation (96%) were similar between DA and alternative approach groups. Conclusion The DA approach to THA performed for FNF appears safe with improved outcomes compared with alternative approaches. Larger studies are needed to verify these results.

Clinical Outcomes of Total Hip Arthroplasty With the Anterolateral Modified Watson-Jones Approach for Displaced Femoral Neck Fractures

“…The length of hospital stay was significantly shorter with the anterior approach than with the posterior approach, and better results were attributed to earlier ambulation and rehabilitation. 28 In this study, periprosthetic fractures due to falls were observed in 2 patients after surgery: 1 occurred at 3 weeks post-surgery, and the other occurred at 5 months postsurgery. These patients required reoperation.…”

“…The length of hospital stay was significantly shorter with the anterior approach than with the posterior approach, and better results were attributed to earlier ambulation and rehabilitation. 28 …”

Polyester Mesh with Liquid Adhesive Compared to Incisional Negative Pressure 2 Therapy for Direct Anterior Total Hip Arthroplasty in the 90-day Postoperative Period

“…The use of the direct anterior approach (DAA) for primary and revision total hip arthroplasty (THA) has increased over recent years (Patel, Shah, and Erens 2019). DAA-THA has been associated with a lower risk of dislocation and revision due to instability, shorter hospital length of stay, and early postoperative function compared to posterior-based approaches (Singh et al 2020;Bendich et al 2021;Charney et al 2020;Kurkis et al 2021;Ponzio et al 2018;Elstad et al 2021). However, an increase in wound complications has been demonstrated following DAA-THA, likely due to increased exposure to anatomical bacterial reservoirs compared to the direct lateral (DL) and posterior approaches (PA) (Kurkis et al 2021;Purcell et al 2018;Shohat et al 2021).…”