Short-term Outcomes of Femoral Neck Fractures Treated With Hemiarthroplasty Using the Anterior Approach

The direct anterior approach has recently gained popularity for patients undergoing elective total hip arthroplasty. It is unknown whether the reported benefits of the direct anterior approach to elective total hip arthroplasty can be extrapolated to patients undergoing hemiarthroplasty after femoral neck fracture. A retrospective review of 101 patients was performed to compare the outcomes of patients treated with hemiarthroplasty using the direct anterior approach (group 1) with those of patients undergoing the procedure with the posterior, anterolateral, or lateral approach (group 2). No differences in age, American Society of Anesthesiologists classification, and preinjury ambulatory status were identified between treatment groups. No difference in operative time was found between those undergoing the anterior approach (98.7 minutes) and those undergoing other surgical approaches (96.5 minutes) (P=.76). No difference in either the need for transfusion or the number of blood products transfused was seen (P=.21) postoperatively. Patients undergoing the direct anterior approach were more likely to be discharged by postoperative day 3 (P=.004) despite no difference in the recorded number of feet ambulated in the hospital. At a mean clinical follow-up of 16 weeks, there was no difference in the rate of return to baseline ambulatory status between groups (P=.07). The overall rates of major and minor complications for all patients were 23% and 26%, respectively, with no statistically significant differences between groups. The overall dislocation rate of all patients was found to be 3%. All dislocations were observed in group 2. Larger prospective studies are needed to further define the benefits of the direct anterior approach in this patient population.