A comparative study between anterior and posterior approach for bipolar hemiarthroplasty in intracapsular fracture neck of femur


  • Johney Juneja Department of Orthopedics, RNT Medical College, Udaipur, Rajasthan, India http://orcid.org/0000-0001-8787-4314
  • Mohzin Asiger Department of Orthopedics, RNT Medical College, Udaipur, Rajasthan, India
  • Ishan Sharma Department of Orthopedics, RNT Medical College, Udaipur, Rajasthan, India
  • Nitin Andrews Department of Orthopedics, RNT Medical College, Udaipur, Rajasthan, India
  • Vinay Joshi Department of Orthopedics, RNT Medical College, Udaipur, Rajasthan, India
  • Ramesh Sen Department of Orthopedics, Max Hospital, Mohali, Punjab, India




Intracapsular neck femur fracture, Hemiarthroplasty posterior approach, Anterior approach, Harris hip score


Background: The present study was undertaken to to compare the efficacy of treatment of intracapsular neck of femur fracture operated by anterior and posterior approaches.

Methods: A total 100 patients of either sex, aged >65 years with intracapsular neck femur fracture were operated with hemiarthroplasty. The patients were divided into two equal groups and patients were operated alternatively one with anterior approach and the second with posterior approach. Functional outcomes were compared using Harris hip score and range of movements assessed clinically. Hip function and final outcome measures were noted and compared between two groups.

Results: The mean age of patients was 63.1±5.3 years in group A and 65.8±5.4 years in group B with female to male ratio was 1.7:1 for group A and 1.8:1 for group B. Operating time for group A and for group B was 65 and 78 minutes respectively. Mean intraoperative blood loss was 120 ml in group A and 150 ml in group B. The most common complication in both the groups were infection and rate in group A was 9.70% and in group B was 13.50%. Posterior approach carried an increased risk of prosthetic dislocation as compared to anterior approach. There was no intraoperative mortality seen in follow up period.

Conclusions: Anterior approach for hip hemiarthroplasty in elderly population with intracapsular femoral neck fractures provided significant benefit in early postoperative period when compared to the posterior approach in terms of duration of surgery, intraoperative blood loss, time of recovery, hip dislocation rate.


Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15000 adults: the influence of age and gender. J Bone Joint Surg Bri. 1998;80(2):243-8.

Dennison E, Mohamed MA, Cooper C. Epidemiology of osteoporosis. Rheumatic Dis Clin. 200632(4):617-29.

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

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

Auffarth A, Resch H, Lederer S, Karpik S, Hitzl W, Bogner R et al. 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. J Trauma Acute Care Surg. 2011;70(5):1257-62.

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

Malchau H, Soderman P, Herberts P. The validity and reliability of Harris Hip Score. Read 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. Int Orthop. 2012;36(11):2219-23.

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

Parker MJ, Dynan Y. Is Pauwels classification still valid? Injury. 1998;29(7):521-3.

Barber TC, Roger DJ, Goodman SB, Schurman DJ. Early outcome of total hip arthroplasty using the direct lateral Vs the posterior surgical approach. Orthopedics. 1996;19:873-5.

Weale E, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study. J Bone Joint Surg. 1996;78:899-902.

Mukka SS, Sayed-Noor AS. An update on surgical approaches in hip arthoplasty: Lateral versus1 posterior approach. HIP Int. 2014;24:7-11.






Original Research Articles