Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Femoral neck fracture is the most common fracture in the elderly population. Hemiarthroplasty is accepted as the gold standard procedure for displaced femoral neck fractures in the elderly worldwide but there is disagreement regarding the optimal surgical approach for the procedure. One of the most commonly used approaches for hip replacement arthroplasty is the Direct Lateral approach or Hardinge approach, which provides excellent exposure but requires partial dissection of gluteus medius muscle insertion, resulting in post-operative abductor dysfunction. This complication could be avoided by using an alternative approach, the direct anterior approach (DAA), which is a muscle-sparing approach. Recent studies indicate that this technique benefits the patient’s recovery and reduces the incidence of complications. This study aimed to compare hip function, postoperative complications and patient mobility after hemiarthroplasty via the direct anterior or lateral approach for a displaced femoral neck fracture in elderly patients. Evaluation of 38 patients randomly allocated into two groups: A Direct Anterior Approach (DAA) (Group 1, n = 18, 7 males, 11 females) or a Hardinge approach (Group 2, n = 20, 10 males, 10 female) was done with a follow up of 6 months. Operative parameters which were reported in the previous literature, like the length of the incision, intraoperative and postoperative complications, amount of blood loss as determined by a drop in haemoglobin and need for blood transfusion and rate of dislocation, were compared. The hip function was compared using the Harris hip score (HHS) at 10 days, 6 weeks, 3 months and 6 months. Harris Hip Scores of the anterior group were 21.8±2.1 at 10 days, 59.3±2.0 at 6 weeks, 78.4±4.0 at 10-12 weeks and 95.3±1.3 at 6 months. In the latral group, the score was 20.1±2.9, 58.4±5.7, 79.1±3.8 and 95.3±2.1, respectively at 10 days 6 weeks 10-12 weeks and 6 months, respectively. Harris hip scores between the two groups showed a significant difference only at day 10 (p = 0.044) in favour of the direct anterior group. The average incision length was 12.3±3.9 cm in the direct anterior approach group, while the lateral group had a length of 17.26±3.2 cm. It was found to be statistically significant with p<0.01. Both surgical approaches showed similar clinical outcomes regarding hip function and incidence of complications. The Direct Anterior Approach is minimally invasive as a smaller skin incision was needed and used an intermuscular plane to approach the hip.
How to cite this article:
Kiran. R, Vipin George, P.S. John and Ashita Paul. Does the Direct Anterior Approach Offer an Advantage Over the Lateral Approach for Hemiarthroplasty of the Hip.
DOI: https://doi.org/10.36478/10.59218/makrjms.2023.12.6.11
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2023.12.6.11