Cichos, J Orthop Trauma 2021 - Comparison between the Direct Anterior and Posterior Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture

Comparison between the Direct Anterior and Posterior Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture

Cichos, Ghanem, et al.·J Orthop Trauma·2021·28 citations·Retrospective cohort

Purpose

To compare 90-day and 1-year outcomes, including mortality, of femoral neck fracture patients undergoing total hip arthroplasty (THA) by direct anterior approach (DAA) versus posterior approach (PA).

Methods

Design: Retrospective cohort.

Setting: Level I Trauma Center.

Patients: 143 consecutive intracapsular femoral neck fractures treated with THA from 2010 to 2018. The minimum follow-up was 12 months, and the average follow-up was 14.6 months (12–72 months).

Main Outcome Measures: Postoperative outcomes, including discharge ambulation, dislocation, periprosthetic joint infection, revision THA, and mortality at 90 days and 1 year after THA.

Results

Of the 143 THA included, 44 (30.7%) were performed by DAA while 99 (69.3%) were performed by PA.
In-hospital outcomes were similar between the cohorts.
Compared with DAA patients, PA patients were more likely to ambulate without assistance preinjury (88.9% vs. 72.7%, P = 0.025) and be nonambulatory at the time of discharge (27.3% vs. 11.4%, P = 0.049).
There were no significant differences in 90-day and 1-year postoperative outcomes between the DAA and PA groups, including dislocation, periprosthetic joint infection, periprosthetic fracture, mechanical complications, and revision surgery.
Although there was no difference in mortality rate at 90 days, at 1-year follow-up the mortality rate was lower in the DAA group (0% vs. 11.1%, P = 0.018).

Conclusions

Performing THA by DAA provides similar benefits in regards to medical and surgical outcomes compared with the PA for displaced femoral neck fracture. However, the DAA may lead to decreased 1-year mortality rates, possibly, because of improved early ambulation capacity that is an important predictor of long-term mortality.

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

Supplemental

Comparison between the Direct Anterior and Posterior Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture

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Comparison between the Direct Anterior and Posterior Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture

Cichos, Ghanem, et al.·J Orthop Trauma·2021·28 citations·Retrospective cohort

DOI·PubMed

Purpose

To compare 90-day and 1-year outcomes, including mortality, of femoral neck fracture patients undergoing total hip arthroplasty (THA) by direct anterior approach (DAA) versus posterior approach (PA).

Methods

Design: Retrospective cohort.

Setting: Level I Trauma Center.

Patients: 143 consecutive intracapsular femoral neck fractures treated with THA from 2010 to 2018. The minimum follow-up was 12 months, and the average follow-up was 14.6 months (12–72 months).

Main Outcome Measures: Postoperative outcomes, including discharge ambulation, dislocation, periprosthetic joint infection, revision THA, and mortality at 90 days and 1 year after THA.

Results

Of the 143 THA included, 44 (30.7%) were performed by DAA while 99 (69.3%) were performed by PA.
In-hospital outcomes were similar between the cohorts.
Compared with DAA patients, PA patients were more likely to ambulate without assistance preinjury (88.9% vs. 72.7%, P = 0.025) and be nonambulatory at the time of discharge (27.3% vs. 11.4%, P = 0.049).
There were no significant differences in 90-day and 1-year postoperative outcomes between the DAA and PA groups, including dislocation, periprosthetic joint infection, periprosthetic fracture, mechanical complications, and revision surgery.
Although there was no difference in mortality rate at 90 days, at 1-year follow-up the mortality rate was lower in the DAA group (0% vs. 11.1%, P = 0.018).

Conclusions

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

Purpose

To compare 90-day and 1-year outcomes, including mortality, of femoral neck fracture patients undergoing total hip arthroplasty (THA) by direct anterior approach (DAA) versus posterior approach (PA).

Methods

Design: Retrospective cohort.

Setting: Level I Trauma Center.

Patients: 143 consecutive intracapsular femoral neck fractures treated with THA from 2010 to 2018. The minimum follow-up was 12 months, and the average follow-up was 14.6 months (12–72 months).

Main Outcome Measures: Postoperative outcomes, including discharge ambulation, dislocation, periprosthetic joint infection, revision THA, and mortality at 90 days and 1 year after THA.

Results

Of the 143 THA included, 44 (30.7%) were performed by DAA while 99 (69.3%) were performed by PA.
In-hospital outcomes were similar between the cohorts.
Compared with DAA patients, PA patients were more likely to ambulate without assistance preinjury (88.9% vs. 72.7%, P = 0.025) and be nonambulatory at the time of discharge (27.3% vs. 11.4%, P = 0.049).
There were no significant differences in 90-day and 1-year postoperative outcomes between the DAA and PA groups, including dislocation, periprosthetic joint infection, periprosthetic fracture, mechanical complications, and revision surgery.
Although there was no difference in mortality rate at 90 days, at 1-year follow-up the mortality rate was lower in the DAA group (0% vs. 11.1%, P = 0.018).

Conclusions

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

Purpose

To compare 90-day and 1-year outcomes, including mortality, of femoral neck fracture patients undergoing total hip arthroplasty (THA) by direct anterior approach (DAA) versus posterior approach (PA).

Methods

Design: Retrospective cohort.

Setting: Level I Trauma Center.

Patients: 143 consecutive intracapsular femoral neck fractures treated with THA from 2010 to 2018. The minimum follow-up was 12 months, and the average follow-up was 14.6 months (12–72 months).

Main Outcome Measures: Postoperative outcomes, including discharge ambulation, dislocation, periprosthetic joint infection, revision THA, and mortality at 90 days and 1 year after THA.

Results

Of the 143 THA included, 44 (30.7%) were performed by DAA while 99 (69.3%) were performed by PA.
In-hospital outcomes were similar between the cohorts.
Compared with DAA patients, PA patients were more likely to ambulate without assistance preinjury (88.9% vs. 72.7%, P = 0.025) and be nonambulatory at the time of discharge (27.3% vs. 11.4%, P = 0.049).
There were no significant differences in 90-day and 1-year postoperative outcomes between the DAA and PA groups, including dislocation, periprosthetic joint infection, periprosthetic fracture, mechanical complications, and revision surgery.
Although there was no difference in mortality rate at 90 days, at 1-year follow-up the mortality rate was lower in the DAA group (0% vs. 11.1%, P = 0.018).

Conclusions

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.