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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2012

Open Access 01-12-2012 | Research article

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

Authors: Felix Renken, Svenja Renken, Andreas Paech, Michael Wenzl, Andreas Unger, Arndt P Schulz

Published in: BMC Musculoskeletal Disorders | Issue 1/2012

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Abstract

Background

A 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.

Methods

Sixty 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.

Results

A 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.

Conclusions

Comparing 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.
Appendix
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Literature
1.
Becker DJ, Kilgore ML, Morrisey MA: The societal burden of osteoporosis. Curr Rheumatol Rep. 2010, 12 (3): 186-191. 10.1007/s11926-010-0097-y.CrossRefPubMed
2.
Frerichmann U, Raschke MJ, Stockle U, Wohrmann S, Lohmann R: Proximal femoral fractures in the elderly. Data from health insurance providers on more than 23 million insured persons--part 2. Unfallchirurg. 2007, 110 (7): 610-616. 10.1007/s00113-007-1258-y.CrossRefPubMed
3.
Roche JJ, Wenn RT, Sahota O, Moran CG: Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005, 331 (7529): 1374-10.1136/bmj.38643.663843.55.CrossRefPubMedPubMedCentral
4.
Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD: Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma. 1997, 11 (3): 162-165. 10.1097/00005131-199704000-00004.CrossRefPubMed
5.
Clayer MT, Bauze RJ: Morbidity and mortality following fractures of the femoral neck and trochanteric region: analysis of risk factors. J Trauma. 1989, 29 (12): 1673-1678. 10.1097/00005373-198912000-00016.CrossRefPubMed
6.
Siebert HR, Beck A: Trauma surgery in the elderly. Chirurg. 2005, 76 (2): 139-150. 10.1007/s00104-004-0980-z.CrossRefPubMed
7.
Becker C, Gebhard F, Fleischer S, Hack A, Kinzl L, Nikolaus T, Muche R: Prediction of mortality, mobility and admission to long-term care after hip fractures. Unfallchirurg. 2003, 106 (1): 32-38. 10.1007/s00113-002-0475-7.CrossRefPubMed
8.
Group PTC: Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000, 355 (9212): 1295-1302.CrossRef
9.
Muraki S, Yamamoto S, Ishibashi H, Nakamura K: Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab. 2006, 24 (2): 100-104. 10.1007/s00774-005-0654-z.CrossRefPubMed
10.
Giusti A, Barone A, Razzano M, Pizzonia M, Oliveri M, Pioli G: Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: one-year follow-up. Aging Clin Exp Res. 2008, 20 (3): 253-259.CrossRefPubMed
11.
Folman Y, Gepstein R, Assaraf A, Liberty S: Functional recovery after operative treatment of femoral neck fractures in an institutionalized elderly population. Arch Phys Med Rehabil. 1994, 75 (4): 454-456. 10.1016/0003-9993(94)90171-6.CrossRefPubMed
12.
Murphy SB, Tannast M: Conventional vs minimally invasive total hip arthroplasty. A prospective study of rehabilitation and complications. Orthopade. 2006, 35 (7): 761-764. 10.1007/s00132-006-0969-z. 766–768CrossRefPubMed
13.
Nielsen KA, Jensen NC, Jensen CM, Thomsen M, Pedersen L, Johnsen SP, Ingeman A, Bartels PD, Thomsen RW: Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study. BMC Health Serv Res. 2009, 9: 186-10.1186/1472-6963-9-186.CrossRefPubMedPubMedCentral
14.
Bender B, Nogler M, Hozack WJ: Direct anterior approach for total hip arthroplasty. Orthop Clin North Am. 2009, 40 (3): 321-328. 10.1016/j.ocl.2009.01.003.CrossRefPubMed
15.
Vavken P, Kotz R, Dorotka R: Minimally invasive hip replacement–a meta-analysis. Z Orthop Unfall. 2007, 145 (2): 152-156. 10.1055/s-2007-965170.CrossRefPubMed
16.
Cheng T, Feng JG, Liu T, Zhang XL: Minimally invasive total hip arthroplasty: a systematic review. Int Orthop. 2009, 33 (6): 1473-1481. 10.1007/s00264-009-0743-z.CrossRefPubMedPubMedCentral
17.
Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE: Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. J Bone Joint Surg Am. 2007, 89 (6): 1153-1160. 10.2106/JBJS.F.00940.CrossRefPubMed
18.
Hutchings L, Fox R, Chesser TJS: The use of outcome measures in patients with proximal femoral fractures. Injury Extra. 2010, 41 (12): 169-CrossRef
19.
Hutchings L, Fox R, Chesser T: Proximal femoral fractures in the elderly: How are we measuring outcome?. Injury. 2011, 42 (11): 1205-1213. 10.1016/j.injury.2010.12.016.CrossRefPubMed
20.
Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Md State Med J. 1965, 14: 61-65.PubMed
21.
Di Monaco M, Di Monaco R, Manca M, Cavanna A: Functional recovery and length of stay after recurrent hip fracture. Am J Phys Med Rehabil. 2002, 81 (2): 86-89. 10.1097/00002060-200202000-00002.CrossRefPubMed
22.
Diamond TH, Thornley SW, Sekel R, Smerdely P: Hip fracture in elderly men: prognostic factors and outcomes. Med J Aust. 1997, 167 (8): 412-415.PubMed
23.
Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L: Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res. 2009, 467 (9): 2426-2435. 10.1007/s11999-008-0672-y.CrossRefPubMedPubMedCentral
24.
Simanski C, Bouillon B, Lefering R, Zumsande N, Tiling T: What prognostic factors correlate with activities of daily living (Barthel Index) 1 year after para-articular hip fracture? A prospective observational study. Unfallchirurg. 2002, 105 (2): 99-107. 10.1007/s001130100285.CrossRefPubMed
25.
Van Balen R, Essink-Bot ML, Steyerberg E, Cools H, Habbema DF: Quality of life after hip fracture: a comparison of four health status measures in 208 patients. Disabil Rehabil. 2003, 25 (10): 507-519. 10.1080/0963828031000090443.CrossRefPubMed
26.
Weatherall M: One year follow up of patients with fracture of the proximal femur. N Z Med J. 1994, 107 (983): 308-309.PubMed
27.
28.
Fahndrich E, Linden M: Reliability and validity of the Visual Analogue Scale (VAS) (author's transl). Pharmacopsychiatria. 1982, 15 (3): 90-94. 10.1055/s-2007-1019515.CrossRefPubMed
29.
Rachbauer F: Minimally invasive total hip arthroplasty. Anterior approach. Orthopade. 2006, 35 (7): 723-724. 10.1007/s00132-006-0964-4. 726–729CrossRefPubMed
30.
Rachbauer F, Krismer M: Minimally invasive total hip arthroplasty via direct anterior approach. Oper Orthop Traumatol. 2008, 20 (3): 239-251. 10.1007/s00064-008-1306-y.CrossRefPubMed
31.
Watson Jones R: Fractures of the neck of the femur. Br J Surg. 1936, 23: 787-808. 10.1002/bjs.1800239213.CrossRef
32.
Garden RS: Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br Vol. 1961, 43 (4): 647-
33.
Nogler M, Rachbauer F: The direct anterior approach. Minimally invasive total joint arthroplasty. Edited by: Hozack WJ, Michael Nogler MK, Bonutti PM, Franz R, Schaffer JL. 2004, New York Dordrecht Heidelberg London: Springer
34.
Chen LH, Huang QW, Wang WJ, He ZR, Ding WL: The applied anatomy of anterior approach for minimally invasive hip joint surgery. Clin Anat. 2009, 22 (2): 250-255. 10.1002/ca.20750.CrossRefPubMed
35.
Lovell TP: Single-incision direct anterior approach for total hip arthroplasty using a standard operating table. J Arthroplasty. 2008, 23 (7 Suppl): 64-68.CrossRefPubMed
36.
Rachbauer F, Kain MS, Leunig M: The history of the anterior approach to the hip. Orthop Clin North Am. 2009, 40 (3): 311-320. 10.1016/j.ocl.2009.02.007.CrossRefPubMed
37.
Nogler M, Krismer M, Hozack WJ, Merritt P, Rachbauer F, Mayr E: A double offset broach handle for preparation of the femoral cavity in minimally invasive direct anterior total hip arthroplasty. J Arthroplasty. 2006, 21 (8): 1206-1208. 10.1016/j.arth.2006.08.003.CrossRefPubMed
38.
Dorr LD: A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. Bone Joint Surg Am. 2009, 91 (11): 2598-2604. 10.2106/JBJS.H.01225.CrossRef
39.
Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O'Brien S, Beverland D: A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am. 2005, 87 (4): 701-710. 10.2106/JBJS.D.02645.CrossRefPubMed
40.
Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE: Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil. 1979, 60 (1): 14-17.PubMed
41.
Harris WH: Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969, 51 (4): 737-755.PubMed
42.
Preininger B, Jesacher M, Fabsits E, Winkler T: Earlier postoperative mobilization with minimally invasive hip hemiarthroplasty. Der Unfallchirurg. 2011, 114 (4): 333-339. 10.1007/s00113-010-1773-0.CrossRefPubMed
43.
Kaneko K, Ohbayashi A, Okahara H, Iwase H, Kurosawa H: Minimally invasive hemiarthroplasty in femoral neck fractures. Randomized comparison between a mini-incision and an ordinary incision: preliminary results. Eur J Orthop Surg Traumatol. 2005, 15 (1): 19-22. 10.1007/s00590-004-0198-2.CrossRef
44.
Lawlor M, Humphreys P, Morrow E, Ogonda L, Bennett D, Elliott D, Beverland D: Comparison of early postoperative functional levels following total hip replacement using minimally invasive versus standard incisions. A prospective randomized blinded trial. Clin Rehabil. 2005, 19 (5): 465-474. 10.1191/0269215505cr890oa.CrossRefPubMed
45.
Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC: Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial. Clin Orthop Relat Res. 2011, 469 (1): 200-208. 10.1007/s11999-010-1331-7.CrossRefPubMed
46.
Dutka J, Sosin P, Libura M, Skowronek P: Total hip arthroplasty through a minimally invasive lateral approach–our experience and early results. Ortop Traumatol Rehabil. 2007, 9 (1): 39-45.PubMed
47.
Schleicher I: Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. Acta Orthop Belg. 2011, 77 (4): 480-487.PubMed
48.
Mahmood A, Zafar MS, Majid I, Maffulli N, Thompson J: Minimally invasive hip arthroplasty: a quantitative review of the literature. Br Med Bull. 2007, 84: 37-48. 10.1093/bmb/ldm029.CrossRefPubMed
49.
Szendroi M, Sztrinkai G, Vass R, Kiss J: The impact of minimally invasive total hip arthroplasty on the standard procedure. Int Orthop. 2006, 30 (3): 167-171. 10.1007/s00264-005-0049-8.CrossRefPubMedPubMedCentral
50.
Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP: Minimally invasive total hip arthroplasty: a prospective randomized study. J Arthroplasty. 2005, 20 (2): 139-144. 10.1016/j.arth.2004.09.061.CrossRefPubMed
51.
Zhu J, Wan Z, Dorr L: Quantification of Pelvic Tilt in Total Hip Arthroplasty. Clin Orthop Relat Res. 2010, 468 (2): 571-575. 10.1007/s11999-009-1064-7.CrossRefPubMed
52.
Lecerf G, Fessy M, Philippot R, Massin P, Giraud F, Flecher X, Girard J, Mertl P, Marchetti E, Stindel E: Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res OTSR. 2009, 95 (3): 210-10.1016/j.otsr.2009.03.010.CrossRefPubMed
53.
Boy O, Hahn S, Kociemba E: Hüftgelenknahe Femurfraktur. Qualität sichtbar machen BQS-Qualitätsreport. Edited by: Christof Veit JB, Klaus D, Burkhard Fischer D. 2009, BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH, 2008
54.
Baker RP, Squires B, Gargan MF, Bannister GC: Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am. 2006, 88 (12): 2583-2589. 10.2106/JBJS.E.01373.CrossRefPubMed
Metadata
Title
Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach
Authors
Felix Renken
Svenja Renken
Andreas Paech
Michael Wenzl
Andreas Unger
Arndt P Schulz
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2012
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-13-141

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