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No Differences in Major In-Hospital Outcome Metrics When Comparing the Direct Lateral Approach to the Posterior
Steven Morgan1, Stephanie Jarvis2, Alexander Conti1
1Department of Orthopedic Trauma, Swedish Medical Center, Englewood, CO, USA.
Geriatric Orthopaedic Surgery & Rehabilitation
|August 20, 2024
Summary
Comparing surgical approaches for hip fractures, this study found neither the direct lateral nor posterior approach superior in geriatric patients. Physician preference may guide the choice for hemiarthroplasty in displaced femoral neck fractures.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Trauma Surgery
Background:
- Displaced femoral neck fractures are common in geriatric patients.
- Hemiarthroplasty is a common surgical treatment for these fractures.
- The optimal surgical approach for hemiarthroplasty remains debated.
Purpose of the Study:
- To compare in-hospital outcomes for geriatric displaced femoral neck fractures treated with hemiarthroplasty.
- The study specifically evaluated outcomes based on surgical approach: direct lateral versus posterior.
Main Methods:
- Retrospective cohort study of geriatric patients (≥60 years) undergoing hemiarthroplasty for displaced femoral neck fractures.
- Data collected included operative time, length of stay (HLOS), and blood loss volume.
- Comparison between the Harding direct lateral approach and the posterior approach.
Main Results:
- The direct lateral approach was associated with shorter operative time and less blood loss compared to the posterior approach.
- However, the direct lateral approach also resulted in a longer length of hospital stay (HLOS).
- Comorbidities, such as dementia and functional dependence, influenced outcomes, suggesting a role in treatment decisions.
Conclusions:
- Neither the direct lateral nor the posterior surgical approach was found to be superior for hemiarthroplasty in geriatric patients with displaced femoral neck fractures.
- The choice of surgical approach may remain a matter of physician preference.
- Patient comorbidities may play a significant role in modifying outcomes and guiding treatment decisions.
