Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

BMC Musculoskeletal Disorders

Research Article

Michael Wenzl¹  Andreas Paech²  Andreas Unger²  Felix Renken²  Arndt P Schulz³  Svenja Renken⁴ 

[1] Klinikum Ingolstadt, Ingolstadt, Germany;University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, D 23538, Lübeck, Germany;University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, D 23538, Lübeck, Germany;BG Trauma Hospital Hamburg, Bergedorfer Strasse, Hamburg, Germany;University Lübeck, Medical Faculty, Lübeck, Germany;

关键词: Femoral Shaft;    Femoral Neck Fracture;    Barthel Index;    Direct Anterior Approach;    Minimal Invasive Approach;   

DOI  :  10.1186/1471-2474-13-141

 received in 2011-11-09, accepted in 2012-07-02,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundA minimal invasive approach for elective hip surgery has been implemented in our institution in the past. It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery. Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma.MethodsSixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, the so called “direct anterior approach” (DAA) was chosen, in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty.Primary outcome parameter was the mobility as measured by the four-item-Barthel index. Secondary outcome parameters included pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. Radiographs were evaluated.ResultsA statistically significant difference (p = 0,009) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS) showed a statistically significant difference (p = 0,035) at day 16. No difference was evident in the comparison of radiographic results.ConclusionsComparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. There is no radiographic evidence that a minimal invasive technique leads to inferior implant position.Level of Evidence: Level II therapeutic study.

【 授权许可】

Unknown   
© Renken et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.