Safety of total hip arthroplasty for femoral neck fractures using the direct anterior approach: a retrospective observational study in 86 elderly patients

摘要

Background The femoral neck fracture is one of the most common fractures in the elderly. A variety of methods and approaches are used to treat it. Total hip arthroplasty is a preferred approach in independent, mobile, elderly patients, given its more favorable long-term outcome. Our hypothesis is that the direct anterior approach in geriatric trauma patients has a lower dislocation-rate with the advantage of early recovery due to a muscle sparing approach and therefore early possible full weight-bearing. Methods Patients were retrospectively sought who suffered a femoral neck fracture from 2008 to 2013. All patients were treated through a direct anterior approach and using the same brand of implants. Medical history, standardized physical exam, conventional pelvic plain and axial hip x-rays, Harris Hip Score, Merle D'Aubigné and Postel and SF-36 were assessed. Results Eighty-six patients were included in the study with a mean age of seventy-five years. The mortality rate was 16.7?%. Complications were encountered in nineteen patients (22.0?%) who needed operative revision and one postoperative complication (1.2?%) which could be handled conservatively. There were five intraoperative complications (5.8?%), two dislocations (2.3?%), one aseptic loosening in a non-cemented stem (1.2?%), six periprosthetic fractures in non-cemented stems (6.9?%), one displacement of a non-cemented cup (1.2?%), two early infections (2.3?%) and three hematomas (3.5?%) recorded. Conclusions Although the direct anterior approach is associated with a rather long learning curve we have found it to preserve the soft-tissues with no injury to abductors. It therefore shows an early advantage in elderly patients in terms of early recovery and therefore early possible full weight-bearing. Fracture treatment with dual mobility cups might lead to lower dislocation rates, but are associated with higher costs. Due to higher complication rates in non-cemented versus cemented shafts, we have changed our practice towards favoring cemented femoral stems in patients with suspected or manifest osteoporosis.