The optimal approach in hip hemiarthroplasty: a cohort of 1009 patients.

Background: A hip hemiarthroplasty is the treatment of choice for a displaced femoral neck fracture in elderly patients not eligible for total hip arthroplasty. There is continuing debate about the optimal surgical approach for this operation, with the most commonly used approaches being posterior and lateral.

Objective: To compare the outcomes of the posterior and the lateral approaches in patients with a displaced femoral neck fracture treated by hemiarthroplasty.

Method: A retrospective study was carried out in two high-volume teaching hospitals in the Netherlands. Electronic patient records were searched for patient characteristics, the operative approach and adverse outcomes.

Results: A total of 1009 patients with a median age of 86 years were included. The posterior approach was used in 51.1% of patients. There were no differences in surgical site infection and periprosthetic fracture rates. There was a trend towards more dislocations in the posterior approach (2.9% vs. 1.4% with an OR of 2.1, 95% CI 0.8-5.1). An uncemented hemiprosthesis was used in 62.7% of patients. Deep surgical site infections and periprosthetic fractures occurred more often in the uncemented group (OR 2.9 and 7.4, respectively).

Conclusion: No differences in adverse outcomes between both approaches could be shown. This study did confirm the relatively high incidence of post-operative complications in uncemented prostheses. Therefore, the cemented prosthesis should be the treatment of choice, with the approach dependent on surgeon preference and experience.