A Comparative Analysis of Posterior and Lateral Approaches in Hip Hemiarthroplasty of Patients Older than 65 Years Regarding Dislocation and Periprosthetic Fracture Rates

Abstract

Aim:The two most commonly used approaches for hip hemiarthroplasty operations are the lateral and posterior approaches (PAs). The PA is claimed to have a higher risk of dislocation. In this context, we aimed to investigate if there is a difference between posterior and lateral approaches (LAs) in terms of postoperative dislocation rates. Mortality rates and the risk of operative periprosthetic fracture were also analyzed.Methods:A retrospective investigation was conducted of patients who underwent hip hemiarthroplasty for a femur neck fracture at our hospital between 2010 and 2020. The operation notes, medical records in the hospital electronic records system, and the Turkish national health record system (E-nabız personal health system) were reviewed. Patients with additional severe diseases or trauma that may affect the risk of dislocation were excluded from the study. Patients were grouped into the PA group and the LA group. PAs were performed using the Moore technique, and LAs were performed using the modified Hardinge technique. Dislocation, periprosthetic fractures, and mortality rates were noted.Results:There were 321 females and 147 male patients in the study. The PA group included 262 patients, and the LA group, 206. There were 6 dislocations and 5 periprosthetic fractures in the PA group and 2 dislocations and 1 periprosthetic fracture in the LA group, with a minimum of 1-year follow-up. The difference was not statistically significant. The mortality rates in postoperative years 1 and 10 were 26.4% and 82.1%, respectively. The lateral versus PA had no statistically significant effect on these rates.Conclusion:Since there was no significant difference between these approaches in terms of dislocation, periprosthetic fracture, and mortality rates; it was concluded that the choice of approach should depend on surgeon preference and experience.

Keywords

• hip dislocation
• hemiarthroplasty
• postoperative complications
• femoral neck fractures
• periprosthetic fractures