Hemiarthroplasty for Hip Fractures - What are the Consequences of Surgical Approach Adoption?

Scientific Background: Hemiarthroplasty is a common treatment for acute hip fractures and one of the commonest conducted procedures in orthopedics. Several surgical approaches are in use and the most commonly used are the direct lateral and posterior approach.

In our department, we have switched from the direct lateral approach to the posterior and direct anterior approaches due to their gluteal sparing and rapid return to ambulation.

The aim of this study was to evaluate the consequences of adaptation to a different surgical approach in a common procedure, including the short-term complication rate and learning curve.

Patients and Methods: A retrospective clinical trial of 127 patients that underwent bipolar hemiarthroplasty for the treatment of acute displaced intracapsular hip fracture in a direct lateral or posterior approach between 1.1.2017 and 31.12.2017 in the Sheba medical center. The primary outcomes included dislocations, periprosthetic fractures and surgical site infections within 90 days postop. Data were collected for- blood loos, blood transfusions, need for subsequent revision surgery and death within 3 months.

Results: The mean age was 83.5, 77 were female (61%). There were 63 patients that were operated with the direct lateral approach and 64 patients that underwent a posterior approach. There were no relevant differences between the treatment groups.

The only statistically significant difference in short-term complications between the groups was an increased rate of dislocations in the posterior approach group (4/64, 6.25% Vs. 0/63, P value = 0.04).

Conclusion: The posterior approach showed an increased risk for prosthetic dislocations within 90 days compared to the direct lateral approach. When choosing the posterior approach, patient population should counterbalance the risks, and the potential learning curve should be taken into consideration.