Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures
Introduction Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly
require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases.
Material and methods In the present retrospective study geriatric patients with FNF (n=100) treated either by anterior
minimal-invasive surgery (AMIS; n=50) or lateral conventional surgery (LCS; n=50) were characterized (age at the time
of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative
parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration
of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and
12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed.
Results Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and
complication rates did not difer between the two groups. Further, more patients in the AMIS group achieved full weightbearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients
in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before
the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often
than patients of the LCS group. No signifcant diferences in functional and surgery-related performance could be observed
between AMIS and LCS group at 12 months postoperatively.
Conclusions In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in
the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in
these vulnerable patients
