Surgical Approach and Dislocation Risk After Hemiarthroplasty in Geriatric Patients With Femoral Neck Fracture With...

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Trauma Surgery

Background:

• Femoral neck fractures are common, especially in elderly patients.
• Hemiarthroplasty is a standard treatment for femoral neck fractures.
• Cognitive impairment is prevalent in this patient population and may influence outcomes.

Purpose of the Study:

• To investigate the association between surgical approach and hip dislocation risk after hemiarthroplasty for femoral neck fractures.
• To compare dislocation rates between cognitively impaired and cognitively intact patients.
• To assess the impact of dislocation on patient mortality.

Main Methods:

• Retrospective study of 828 patients undergoing hemiarthroplasty for femoral neck fractures.
• Patients were categorized into cognitively impaired (290) and cognitively intact (538) groups.
• Surgical approaches analyzed included direct anterior (DA), modified Hardinge (MH), and posterior (PA).

Main Results:

• The overall dislocation rate was 2.1%, with higher rates in the cognitively impaired (3.4%) versus intact (1.3%) groups.
• The posterior approach (PA) had the highest dislocation rate (5.1%), especially in cognitively impaired patients (10.1%).
• Dislocation was associated with a 3.2-fold increased hazard of death (P=0.0226).

Conclusions:

• The posterior approach is associated with a significantly higher risk of prosthetic hip dislocation following hemiarthroplasty for femoral neck fractures.
• Cognitively impaired patients face a particularly elevated dislocation risk with the posterior approach.
• Surgical approach selection warrants careful consideration to mitigate dislocation and improve patient survival.