Abstract: Objective: To compare the clinical outcome of anterolateral and the posterior approach of hemiarthroplasty for treatment of neck of femur fractures in elderly patients
Methods: The study was carried out on 84 patients who suffered from displaced femoral neck fractures
(48 cases of Garden type III, 36 cases of Garden type IV) treated by hemiarthroplasty either by anterolateral (Watson Jones) approach or posterior (Southern Moore’s). The average age of the patients was 68.1 years (range: 55-79 years). They were divided into anterolateral group (44 cases) and posterior group (40 cases). The average time of follow-up was 6 months. The anterolateral approach as popularized by Watson and Jones goes through the interval between the gluteus medius and the tensor fascia latae, to reach the femoral neck from anterior capsule. The traditional posterior approach as described by Moore (Southern incision) includes dividing the insertions of short external rotator muscles (the obturator externus and superior and inferior gemeli), approaching the femoral neck from posterior capsule. The variables under observation were length of incision, operative time, post operative pain, length of hospital stay and bed stay and post-operative dislolcation rate.
Results: The length of the skin incision ranged from 8 cm to 12 cm with the anterolateral technique, against 13-20 cm in the posterior approach. It took average 3 minutes lesser to complete the anterolateral approach (32min±9min), compared with the conventional approach (35min ±10min). The average post operative Harris hip score was 90.03±11.05 in anterolateral approach against 85.23±10.05 in the posterior approach. The average length of hospitalisation for patients with the anterolateral approach was (9.4±2.2) days (range: 6-12 days), which was (12.2±3.1) days (range: 9-15 days) in the posterior approach. The average length of bed stay was (4.4±1.1) days (range: 3-6 days) in anterolateral group and (6.2±2.8) days (range: 3-10 days) in posterior group. No patients in anterolateral group experienced dislocation. Two patients (5%) hip in posterior approach had dislocation.
Conclusions: Anterolateral mini-invasive approach can decrease operative trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit faster postoperative rehabilitation, which can in turn reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing hemiarthroplasty.
