Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach

Abstract

Aim: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty (BHA) using a direct anterior approach.

Methods: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach (DAA) or the posterior approach (PA). The mean observation period was 36 mo. The age, sex, body mass index (BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared.

Results: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group (P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.

Conclusion: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.

Keywords: Bipolar hemiarthroplasty; Direct anterior approach; Femoral neck fracture; Muscle presentation; Posterior approach; Walking ability.

Figure 1

Since the anteroposterior width of Accolade TMZF stem is narrow and rasping of the greater trochanter is not necessary, this stem could be readily used for the direct anterior approach. Anteroposterior and lateral views on X-ray radiography after bipolar hemiarthroplasty.

Figure 2

Walking ability before injury and after the operation. DAA: Direct anterior approach; PA: Posterior approach; op: Operation.