The Role of Total Hip Arthroplasty Through the Direct Anterior Approach in Femoral Neck Fracture and Factors Affecting the Outcome

Abstract

Background: Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly population. Total hip arthroplasty (THA) is the preferred treating method in active, cognitively intact patients. The direct anterior approach (DAA) has suggested a lower dislocation risk and a significant reduction in postoperative pain and recovery time in elective THA. This study aimed to compare clinical outcomes, perioperative complications, and mortality of THA through the DAA between FNF and elective cases.

Methods: Patients with displaced FNF (n = 150) who received THA through the DAA were matched for gender, age, body mass index, and American Society for Anesthesiologists score with electively treated patients (n = 150). The perioperative complications, clinical and radiologic outcomes, as well as mortality were compared between groups, retrospectively.

Results: FNF patients had an increased blood loss, operation duration, hospital stay, and mortality but similar surgery-related complication rates compared to their elective counterparts. The mortality was, however, lower than that reported in the literature. Age, American Society for Anesthesiologists score, and time-to-operation affected the duration of hospital stay and mortality. Less experienced surgeons did not have increased surgery-related complications, but longer operation time and higher blood loss compared to experienced surgeons.

Conclusion: THA through the DAA might be a credible and safe option for patients presenting an FNF, with excellent functional outcomes, less surgery-related complications, and lower short-term and long-term mortality than those reported in the literature. Early intervention and perioperative stabilization of the patients with FNF could potentially increase the survival rate.

Keywords: clinical outcomes; complications; direct anterior approach; femoral neck fracture; mortality; total hip arthroplasty.