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Published on: September 7, 2022
The John Charnley Award: The Anterior Approach Does Not Improve Recovery after Hemiarthroplasty for Femoral Neck
Taylor Woolnough1, Isabel Horton1, Simon Garceau1
1Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Background:
Evidence supporting the anterior approach (AA) over the lateral approach (LA) in patients undergoing hemiarthroplasty for intracapsular hip fracture, while promising, is inconsistent and largely retrospective. The purpose of this study was to compare the AA to the LA for early function, time to discharge, pain, and complications in patients undergoing hemiarthroplasty for hip fracture.
Methods:
A multisurgeon, single-center, randomized controlled trial was performed. There were 102 patients undergoing hemiarthroplasty for acute femoral neck fractures randomized to AA (n = 50) or LA (n = 52). All procedures were performed by fellowship-trained arthroplasty surgeons using cemented (92 of 102) or uncemented (10 of 102) stems. The primary outcome was patient function assessed using the Barthel-20 Index at 6 weeks. Secondary outcomes included pain (visual analog scale pain), EuroQol-5 Dimension global health assessment, length of stay, and complications. Outcomes were assessed at 2, 6, 12, and 26 weeks.
Results:
Barthel-20 Index score did not differ between groups at 6 weeks (AA: 15.8 ± 5.3; LA: 15.8 ± 5.2, P = 0.98) or at any other time. The EuroQoL-5 Dimension and visual analog scale pain were not different. The mean length of hospital stay (P = 0.23) and time from surgery to rehabilitation discharge (P = 0.87) were not different. There was no difference in readmission or emergency department visits within 90 days (P = 0.86) or 90-day mortality (P = 0.92). There was no difference in reoperations (AA: two of 50; LA: one of 52, P = 0.54) or medical complications (P = 0.365).
Conclusions:
The AA is not associated with superior recovery or early-term outcomes in hip fracture patients. At present, without proven benefit, widespread adoption of the AA in this population is not recommended, particularly considering the learning curve and specialized equipment requirements.
