Prospective study comparing early functional outcome and gait analysis in femoral neck fracture treated by cemented hemiarthroplasty using modified Hardinge approach and conventional posterior approach
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20223440Keywords:
Femoral neck fracture, Cemented hemiarthroplasty, Hardinge approach, Posterior approachAbstract
Background: A prospective study was done to compare the outcomes of management of fracture neck of femur by cemented hemiarthroplasty using modified Hardinge approach and conventional posterior approach
Methods: The 2019 to 2022 50 patients underwent bipolar hemiarthroplasty for femoral neck fracture. Group A (Femoral neck fracture treated using conventional posterior approach) and group B (Femoral neck fracture treated using modified Hardinge approach) with 25 patients in each group. Outcomes were evaluated based on mean surgical time and Harris hip score and SF-36.
Results: Mean duration of surgery in minutes was more for modified Hardinge approach. Harris hip score with standard deviation for modified Hardinge Approach for follow-ups was better and statistically significant than posterior approach. Similarly, quality of life after surgery, in terms of mean SF-36 score with standard deviation for modified Hardinge approach was better and statistically significant than posterior approach. Modified Hardinge approach has fewer complications in comparison to the posterior approach. With the advantages comes a longer learning curve to operate without complications. Hence, with proper surgical technique, and proper tight closure, we prefer the modified Hardinge approach over other approaches as it had nil dislocations and abductor lurch.
Conclusions: Modified Hardinge approach for hip arthroplasty in elderly people with femoral neck fracture provide significant benefit in the early post operative period when compared to conventional posterior approach in terms of post operative pain, time of recovery, dislocation rate and quality of life.
References
Comstock C, Imrie S, Goodman SB. A clinical and radiographic study of the “safe area” using the direct lateral approach for total hip arthroplasty. J Arthroplasty. 1994;9(5):527-31.
Frndak PA, Mallory TH, Lombardi Jr AV. Translateral surgical approach to the hip. The abductor muscle" split". Clin Orthop Rel Res. 1993;(295):135-41.
Gregory RJ, Gibson MJ, Moran CG. Dislocation after primary arthroplasty for subcapital fracture of the hip. Wide range of movement is a risk factor. J Bone Joint Surg Bri. 1991;73(1):11-2.
Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Bri. 1982;64(1):17-9.
Hongisto MT, Nuotio MS, Luukkaala T, Väistö O, Pihlajamäki HK. Lateral and posterior approaches in hemiarthroplasty. Scandinavian J Surg. 2018;107(3):260-8.
Kalyanasundaram S, Krishnathas K. Modified Hardinge approach for lesser complications. J Evid Based Med Healthc. 2020;7(30):1512-6.:
Moore AT. The self-locking metal hip prosthesis. JBJS. 1957;39(4):811-27.
Madanat R, Mäkinen TJ, Ovaska MT, Soiva M, Vahlberg T, Haapala J. Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case–control study. Int Orthop. 2012;36(5):935-40.
Rogmark C, Fenstad AM, Leonardsson O, Engesæter LB, Kärrholm J, Furnes O et al. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients: An analysis of 33,205 procedures in the Norwegian and Swedish national registries. Acta Orthop. 2014;85(1):18-25.
Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ. Dorsal versus trans-gluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. Int Prthop. 2012;36(11):2219-23.
Minns RJ, Crawford RJ, Porter ML, Hardinge K. Muscle strength following total hip arthroplasty: a comparison of trochanteric osteotomy and the direct lateral approach. J Arthropl. 1993;8(6):625-7.
Lusty PJ, Walter WL and Young D. Posterior and posteroinferior approaches. In: Hozack W, Parvizi J and Bender B (eds) Surgical treatment of hip arthritis: reconstruction, replacement, and revision. Philadelphia: Saunders Elsevier. 2010;122-6.
Sariali E, Leonard P, Mamoudy P. Dislocation after total hip arthroplasty using Hueter anterior approach. J Arthroplasty. 2008;23(2):266-72.
Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Rel Research. 2005;441:115-24.
Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Rel Res. 2002;405:46-53.
Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin N Am. 2009;40(3):311-20.
Nogler M. The direct anterior approach. In: Hozack W, Parvizi J and Bender B (eds) Surgical treatment of hip arthritis: reconstruction, replacement, and revision. Philadelphia: Saunders Elsevier. 2010; 99-107.
Roberts JM, Fu FH, McClain EJ, Ferguson Jr AB. A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop Rel Res. 1984;(187):205-10.
Baker AS, Bitounis VC. Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Joint Surg Bri. 1989;71(1):47-50.
Barber TC, Roger DB, Goodman SB, Schurman DJ. Early outcome of total hip arthroplasty using the direct lateral vs the posterior surgical approach. Orthopedics. 1996;19(10):873-5.
Bhandari M, Devereaux PJ, Tornetta III P, Swiontkowski MF, Berry DJ, Haidukewych G et al. Operative management of displaced femoral neck fractures in elderly patients: an international survey. JBJS. 2005;87(9):2122-30.
