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Short-term outcomes of hemiarthroplasty for displaced femoral neck fractures in elderly patients: Direct anterior approach versus postero-lateral approach

本文另有預刊版本,請見:10.6492/FJMD.201908/PP.0001

摘要


Background: The direct anterior approach (DAA) in total hip arthroplasty has been reported to decrease soft tissue damage and to improve post-operative recovery. We hypothesized that DAA may be useful in hemiarthroplasty for femoral neck fractures. Purpose: The aim of this study is to compare the short-term outcomes between DAA and postero-lateral approach (PLA) in elderly patients treated with hemiarthroplasty for displaced femoral neck fractures. Methods: Between 2016 and 2017, 125 patients with femoral neck fractures underwent bipolar hemiarthroplasty. DAA was performed in 60 patients and PLA in 65 patients. The age, sex, body height, body weight, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, operative time, estimated blood loss, length of hospital stay, post-operative pain, functional score, and complications were recorded and compared. Results: There was no significant difference in age, sex, BMI, and ASA classification between the two groups. Operative time was significantly longer in the DAA group (77.0 vs. 58.7 minutes; p < 0.01). The mean pain visual analog scale (VAS) in the first 3 days after operation, 2 weeks and 3 months after operation in the DAA group were all lower than those in the PLA group, but only the difference in pain VAS on the third day after operation had statistical significance (p = 0.02). The Harris Hip Score at discharge and 3 months after operation were both higher in the DAA group than in the PLA group, but there was no significant difference (42.75 vs. 41.27; p = 0.90 and 69.73 vs. 68.75; p = 0.67, respectively). The length of hospital stay was shorter in the DAA group, although without statistical significant difference (5.9 vs. 6.4 days; p = 0.27). There was no complication in the DAA group, but two complications in the PLA group, including one dislocation and one death. Conclusion: DAA in elderly patients treated with hemiarthroplasty for displaced femoral neck fractures is not inferior to PLA. The findings showed less postoperative pain on the third day after operation in the DAA group. In addition, the DAA and PLA group presented comparable results including the length of hospital stay, blood loss, and functional score. Although the operative time in the DAA group is longer, it might be improved after the learning curve.

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