Direct Anterior vs. Direct Lateral Approach total Hip Arthroplasty for Displaced Femoral Neck Fracture

Purpose: The aim of our study was to assess whether the supine anterior approach gives superior results when compared to the direct lateral approach, for the treatment of displaced femoral neck fracture, in the active elderly patient.

Methods: We assessed clinically two cohorts of active elderly patients who sustained a displaced femoral neck fracture and underwent cementless THA either in the supine anterior approach or in the decubitus direct lateral approach. Patients were assessed using the Harris hip score at discharge and at six weeks follow-up.

Results: 45 patients aged 65-85 were included in the study. 30 patients were operated using the decubitus direct lateral approach, and 15 in the supine direct anterior approach. Prior to discharge, there was no significant difference in total Harris hip score between both groups. Thus, patients in the supine direct anterior approach needed less support on walking and climbed up stairs better. Blood loss was similar in both groups. Length of hospital stay was shorter in the direct anterior approach group: 5 vs. 6.87 days.

At 6 weeks follow-up the total Harris hip score was similar in both groups. Thus, patients in the supine anterior approach could walk for longer distances, needed less support on walking, and limped less compared to the patients in the direct lateral approach. On calculation of the walking measurements only in the Harris hip score, the results were significantly better for the direct anterior approach (14+5.44 vs 8.5+5.35; p=0.018).

Discussion and Conclusions: Our study suggests that in cases of displaced femoral neck fractures in the active elderly, the preffered approach for THA is the direct anterior approach. The patients walk independently earlier and stay for shorter periods in the hospital.