Treatment of Femoral Neck Fracture with a Minimal Invasive Surgical Approach for Hemiarthroplasty – Clinical and Radiological Results in 180 Geriatric Patients

Abstract

Purpose : The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH.Materials and Methods : The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery.Results : After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length.Conclusion : Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible.

Minimally invasive anterior muscle-sparing versus a transgluteal approach for hemiarthroplasty in femoral neck fractures-a prospective randomised controlled trial including 190 elderly patients

“…In a literature review on minimally invasive THA, Jung et al [ 62 ] reported consistently lower levels of pain and use of analgesics. The same effect has been documented after HA for FNFs in retrospective and prospective analyses [ 30 , 31 , 63 ], and this effect was also present in our data set, with patients in the AMIS-arm on average suffering lower levels of pain. However, the effect did not reach significance, unlike in previous studies [ 31 , 63 ], and must be interpreted with caution since the agreement between formal ratings and verbal expressions of pain or discomfort seems to decrease with advancing age [ 64 ], and the reliability with cognitive impairment might be additionally limited.…”

Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty

“…In this series, 83.8% of patients were ambulatory on postoperative day 1 and 94.6% were ambulatory before discharge. In contrast, Unger et al [38] describe a series of 180 patients who underwent hemiarthroplasty for femoral neck fracture with the direct anterior approach, and found a 7.3% rate of previous ambulatory patients needing a wheelchair for mobilization at discharge. Time to ambulation after surgery has been shown to be an independent predictor of pneumonia, delirium, and length of hospital stay, and it is possible that adopting a tissue-sparing approach such as SuperPATH may reduce these complications [39] .…”

Direct Anterior Approach Versus Posterolateral Approach for Hemiarthroplasty in the Treatment of Displaced Femoral Neck Fractures in Geriatric Patients

“…Femoral neck fractures are serious injuries in elderly due to the increasing number of advanced age population and comorbidities, which is associated with extremely morbidity and mortality rates [1][2][3][4]. Lung infections, deep vein thrombosis, muscular dystrophy, and pressure ulcers are the leading causes of comorbidities [2].…”