In elderly patients, an established treatment for femoral neck
fractures is hip hemiarthroplasty (HHA) using the anterolateral
approach (ALA). Early postoperative mobilization is crucial to
reduce perioperative complications. The direct anterior approach
(DAA) has been reported to facilitate early recovery of ambulation
and is increasingly popular in elective hip surgery but rarely used
in femoral neck fractures. The aim was to compare the outcome of the
DAA and the ALA in patients treated for femoral neck fracture.
MATERIALS AND METHODS
All HHAs with complete data sets were reviewed from a tertiary
public healthcare institution (2013-2020). Propensity score matching
was applied to compensate for possible confounders; outcome
parameters were perioperative blood loss, postoperative mobility and
pain. Secondary outcomes were duration of surgery, length of stay
(LOS), complications, reoperation and mortality rates.
There were 237 patients (mean age 85.8 years) available for
analysis. The DAA group mobilized earlier during hospitalization
(outside patient room: 50.6 vs 38.6%, p = 0.01;
walking on crutches/walker: 48.1 vs 36.1%,
p < 0.01), had shorter surgeries (DAA vs ALA: 72.5
vs 89.5 min, p < 0.001) and a trend towards
fewer complications (32.9% vs 44.9%, p = 0.076). Blood
loss (286 vs 287 ml), LOS (10.4 vs 9.5 days), pain
(cessation of opioid medication: 2.9 vs 3.3 days post-op),
revision (2.5 vs 3.2%) or mortality (30-days: 7.6 vs 5.7%) did not
differ between patient groups.
DAA for HHA led to earlier in-hospital mobility, shorter surgeries
and a tendency towards fewer complications. No advantage was found
regarding perioperative blood loss and pain.