Elstad Zachary M, Buckner Jeannie F, Taunton Michael J, Sherman Courtney E, Ledford Cameron K, Wilke Benjamin K
Investigation Performed at the Department of Orthopedic Surgery, Mayo Clinic Florida Campus, Jacksonville, FL, USA.
Arthroplast Today. 2021 Mar 7;8:92-95. doi: 10.1016/j.artd.2021.02.003. eCollection 2021 Apr.
Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral).
A retrospective review identified 52 patients who underwent primary THA for FNF between 2009 and 2018, including 20 via the DA approach and 32 by alternative approaches. All procedures were exclusively performed by high-volume arthroplasty surgeons. Perioperative results, complications, and clinical outcomes were compared with those of routine statistical methods. Mean follow-up duration was 3 years (range, 1-8).
The average age was 74 years (range, 57-92) with similar baseline characteristics between the 2 groups ( = .09). The DA cohort demonstrated significantly shorter length of stay (3 days vs 5 days, < .01) and discharge to home vs skilled nursing facility (40.0% vs 9.4% = .014). There was a trend toward decreased complications (0% vs 16%, = .08). There were no dislocations or fractures in either cohort. Final Harris Hip Scores (94 vs 81, = .07) and return to community ambulation (96%) were similar between DA and alternative approach groups.
The DA approach to THA performed for FNF appears safe with improved outcomes compared with alternative approaches. Larger studies are needed to verify these results.
对于移位型股骨颈骨折（FNF）进行的全髋关节置换术（THA）在活跃的老年人群中已成为一种越来越常见的治疗方法。骨折情况下与THA手术入路相关的并发症情况尚不清楚。本研究的目的是比较一系列通过直接前路（DA）入路与其他入路（前外侧和后外侧）进行的FNF的THA。
一项回顾性研究确定了2009年至2018年间接受原发性FNF的THA的52例患者，其中20例通过DA入路，32例通过其他入路。所有手术均由高年资关节置换外科医生专门进行。采用常规统计方法比较围手术期结果、并发症和临床结局。平均随访时间为3年（范围1 - 8年）。
平均年龄为74岁（范围57 - 92岁），两组之间的基线特征相似（P = 0.09）。DA组的住院时间明显更短（3天对5天，P < 0.01），出院回家的比例高于入住专业护理机构的比例（40.0%对9.4%，P = 0.014）。并发症有减少的趋势（0%对16%，P = 0.08）。两组均无脱位或骨折。DA组和其他入路组的最终Harris髋关节评分（94对81，P = 0.07）以及恢复社区行走的比例（96%）相似。
与其他入路相比，用于FNF的THA的DA入路似乎是安全的，且结局有所改善。需要更大规模的研究来验证这些结果。
