Bipolar hemiarthroplasty of hip joint: prospective randomised comparative study of direct anterior approach versus posterior approach


  • Mukesh Sancheti Department of Orthopaedics, Kingsway Hospitals, Nagpur, Maharashtra, India
  • Mahendra Ghagre Department of Orthopaedics, Dr Ghagre Hospital, Karanja (G), Maharashtra, India



Fracture femur neck, Hemiarthroplasty, Direct anterior approach, Posterior approach


Background: The dilemma while treating cases with hemiarthroplasty is the surgical approach to be employed. The aim of present study is comparison of posterior approach and direct anterior approach with regards to various relevant outcomes and evaluate early surgical complications.

Methods: In this randomized observational study conducted over 2 years, 20 patients each with intra-capsular neck femur fracture were enrolled as per predefined selection criteria and treated with hemiarthroplasty (bipolar) either by posterior approach or by direct anterior approach. Follow up was done for all the patients at regular intervals with standard post-operative protocol, including evaluation for surgical complications, active range of motion and assessment of Harris hip score.

Results: Overall infection rate was 5% (two patients in posterior approach, no patient in direct anterior approach, the difference being statistically insignificant). No incidences of dislocation were reported in either group. Two patients of posterior approach had abductor weakness. Periprosthetic fracture and deep vein thrombosis were observed in one case each in posterior approach group. In posterior surgical group, excellent Harris hip score in 25% patients, good in 57.5% patients and fair in 17.5% patients were observed; while in direct anterior surgical group, excellent score was observed in 12.5% patients, good in 55% patients and fair in 32.5% patients.

Conclusions: No major clinically or statistically significant differences were observed between for outcomes and complications between the two approaches. Larger randomized trials with bigger samples are recommended.

Author Biographies

Mukesh Sancheti, Department of Orthopaedics, Kingsway Hospitals, Nagpur, Maharashtra, India

Senior Consultant, Department of Orthopaedics, Kingsway Hospitals, Nagpur, Maharashtra

Mahendra Ghagre, Department of Orthopaedics, Dr Ghagre Hospital, Karanja (G), Maharashtra, India

Consultant Orthopedician, Dr Ghagre Hospital, Karanja (G), Maharashtra


Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15000 adults: the influence of age and gender. The Journal of bone and joint surgery. British volume. 1998 Mar;80(2):243-8.

Dennison E, Mohamed MA, Cooper C. Epidemiology of osteoporosis. Rheumatic Disease Clinics. 2006 Nov 1;32(4):617-29.

Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury. 1998 Apr 1;29(3):215-8.

Zofka P. Bipolar hip hemiarthroplasty. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 2007 Apr 1;74(2):99-104.

Auffarth A, Resch H, Lederer S, Karpik S, Hitzl W, Bogner R, Mayer M, Matis N. Does the choice of approach for hip hemiarthroplasty in geriatric patients significantly influence early postoperative outcomes? A randomized-controlled trial comparing the modified Smith-Petersen and Hardinge approaches. Journal of Trauma and Acute Care Surgery. 2011 May 1;70(5):1257-62.

Keene GS, Parker MJ. Hemiarthroplasty of the hip—the anterior or posterior approach? A comparison of surgical approaches. Injury. 1993 Oct 1;24(9):611-3.

Malchau H, Soderman P, Herberts P. The validity and reliability of Harris Hip Score. Read at SICOT. 1999:18-23.

Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ. Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. International orthopaedics. 2012 Nov 1;36(11):2219-23.

Parker MJ. Hemiarthroplasty versus internal fixation for displaced intracapsular fractures of the hip in elderly men: a pilot randomised trial. The Bone & Joint Journal. 2015 Jul;97(7):992-6.

Jalovaara P, Virkkunen H. Quality of life after primary hemiarthroplasty for femoral neck fracture: 6-year follow-up of 185 patients. Acta Orthopaedica Scandinavica. 1991 Jan 1;62(3):208-17.

Mukka S, Mahmood S, Kadum B, Sköldenberg O, Sayed-Noor A. Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures. Orthopaedics & Traumatology: Surgery & Research. 2016 Dec 1;102(8):1049-54.

Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates?. Clinical Orthopaedics and Related Research (1976-2007). 2006 Jun 1;447:34-8.

Bush JB, Wilson MR. Dislocation after hip hemiarthroplasty: anterior versus posterior capsular approach. Orthopedics. 2007 Feb 1;30(2):138-44.






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