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Randomized Controlled Trial
. 2012 Aug 8:13:141.
doi: 10.1186/1471-2474-13-141.

Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

Felix Renken  1 , Svenja Renken, Andreas Paech, Michael Wenzl, Andreas Unger, Arndt P Schulz
Affiliations
Randomized Controlled Trial

Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

Felix Renken et al. BMC Musculoskelet Disord. .

Abstract

Background: A minimal invasive approach for elective hip surgery has been implemented in our institution in the past. It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery. Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma.

Methods: Sixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, the so called "direct anterior approach" (DAA) was chosen, in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty.Primary outcome parameter was the mobility as measured by the four-item-Barthel index. Secondary outcome parameters included pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. Radiographs were evaluated.

Results: A statistically significant difference (p = 0,009) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS) showed a statistically significant difference (p = 0,035) at day 16. No difference was evident in the comparison of radiographic results.

Conclusions: Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. There is no radiographic evidence that a minimal invasive technique leads to inferior implant position.

Level of evidence: Level II therapeutic study.

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Figures

Figure 1
Figure 1
Study diagram. CONSORT Flowchart of enrolment and allocation to groups 1 and 2.
Figure 2
Figure 2
Surgical access anatomy. Comparison of access path with DAA (−−−) versus WJA (− − −).
See this image and copyright information in PMC

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