The direct anterior approach is safe and shortens hospital length of stay following hemiarthroplasty for neck of femur fracture

Injury. 2023 Apr;54(4):1186-1190. doi: 10.1016/j.injury.2023.02.016. Epub 2023 Feb 8.

Abstract

Objective: To investigate the safety of using the anterior approach (AA), compared to the lateral approach (LA), in hemiarthroplasty for the treatment of displaced neck of femur fractures.

Design: Retrospective case-control match cohort study.

Setting: Level 1 trauma center.

Patients: Retrospective review of prospectively collected data for 39 consecutive intracapsular hip fractures treated with hemiarthroplasty using an AA between 2017 and 2021. Patients operated with the AA were matched in 1:2 ratio with patients that had hemiarthroplasty via a LA.

Main outcome measures: Discharge destination, 90-day emergency room (ER) visit or readmission rate, inpatient and 90-day mortality rate, inpatient medical complications, 90-day mechanical complications, 90-day reoperation, and length of hospital stay (LOS).

Results: Discharge destination (p = 0.695), 90-day ER visit or readmission rate (p = 0.315), inpatient (p = 0.719) and 90-day mortality rate (p = 0.815), medical complications (p = 0.524), mechanical complications (p = 0.150) were similar between cohorts. Five patients, all in the LA-group, required re-operations within 90-days (p = 0.106). Patients in AA-group had shorter LOS (9.3 days, 95% CI [7.6-11.1] vs. 14.7 days [95% CI 12.2-17.3], p = 0.002).

Conclusions: The AA can be safely introduced for the treatment of hip fractures. Similar short-term outcomes relative to the LA were identified. The shorter LOS may reflect the improved early functional recovery offered from the muscle-sparing AA technique. Future, level-1 data should include early- and longer term functional outcome along with cost-effectiveness.

MeSH terms

  • Arthroplasty, Replacement, Hip* / adverse effects
  • Cohort Studies
  • Femoral Neck Fractures*
  • Hemiarthroplasty* / adverse effects
  • Hip Fractures* / surgery
  • Humans
  • Length of Stay
  • Retrospective Studies
  • Treatment Outcome