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. 2021 Jun;33(6):1635-1644.
doi: 10.1007/s40520-020-01696-9. Epub 2020 Sep 10.

Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study

Mauro Spina  1 , Valentina Luppi  2 , Jacopo Chiappi  2 , Francesco Bagnis  2 , Massimo Balsano  3
Affiliations

Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study

Mauro Spina et al. Aging Clin Exp Res. 2021 Jun.

Abstract

Background: In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs).

Aim: The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs.

Materials and methods: Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months.

Results: Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant.

Conclusions: The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population.

Level of evidence: Level IV, retrospective cohort study.

Keywords: Bipolar hemiarthroplasty; Direct anterior approach; Direct lateral approach; Hip fractures; Total hip arthroplasty.

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References

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