Kantonsspital St.Gallen

Direct anterior approach improves in-hospital mobility following hemiarthroplasty for femoral neck fracture treatment

Andreas Ladurner, T Schöfl, A K Calek, Vilijam Zdravkovic & Karlmeinrad Giesinger


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.

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.
citation Ladurner A, Schöfl T, Calek A K, Zdravkovic V, Giesinger K. Direct anterior approach improves in-hospital mobility following hemiarthroplasty for femoral neck fracture treatment. Arch Orthop Trauma Surg 2021;.
type journal paper/review (English)
date of publishing 04-08-2021
journal title Arch Orthop Trauma Surg
ISSN electronic 1434-3916
PubMed 34347122
DOI 10.1007/s00402-021-04087-5