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BMC Musculoskeletal Disorders

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Open Access 01-12-2017 | Study protocol

Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol

Authors: Max P. L. van der Sijp, Inger B. Schipper, Stefan B. Keizer, Pieta Krijnen, Arthur H.P. Niggebrugge

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Abstract

Background

The Direct Anterior Approach (DAA) is an alternative approach to the currently most used Lateral Approach (LA) for hip replacement in femoral neck fracture patients. Compared to the LA, the DAA minimizes soft tissue damage. Sparing muscle tissue may facilitate early and improved postoperative mobility. It may also be associated with fewer complications, increased quality of life and lower 1-year mortality. The aim of this study is to compare postoperative complications, hip function and patient mobility after hemiarthroplasty via the anterior or lateral approach following a displaced femoral neck fracture.

Methods

138 elderly patients with displaced femoral neck fractures will be operated using either the direct anterior approach or the lateral approach for a hemiarthroplasty in a single centre, prospective, comparative cohort study. The choice of surgical approach will depend on the expertise of the trauma surgeon on call. The primary outcome of this study will be the functionality of the hip after surgery measured using the Harris Hip Score during routine outpatient check-ups. Secondary outcomes include surgical and non-surgical complication rates, admission time, postoperative pain, rehabilitation time, performance in activities of daily living, health-related quality of life measured, cognitive function and balance.

Discussion

Many approaches are known for hip replacement arthroplasty in trauma patients with little consensus on the preferred method. Identifying the best approach facilitating an adequate and fast recovery could optimize patient independence and quality of life and minimize rehabilitation costs, morbidity and mortality rates. The study design will reflect daily clinical practice and aims to present an accurate depiction of clinical outcomes.

Trial registration

This trial entered the Dutch Trial Registry with registration number (NTR)6238 on the 24th of April 2017. http://www.trialregister.nl/trialreg/index.asp. Protocol version 2.0 16–03-2017.

Postoperative bleeding is defined as any blood loss from the operated area.

Implant dislocation is defined as the dislocation of the femoral head from the acetabulum.

Periprosthetic fractures are defined as any visual or X-ray confirmed fractures formed during or after surgery with a fracture-plane in direct contact with the prosthesis.

Wound infection is defined as the presence of the collective calor, dolor, rubor, tumor and pus formation observed by the treating physician. No positive culture is required.

Fistula or pus formation surrounding the prosthesis and/or: two or more positive preoperative cultures of identical micro-organisms or one preoperative puncture culture with one peroperative culture with an identical micro-organism or one positive preoperative or peroperative culture with a virulent micro-organism (S. aureus) or a suspected clinical assessment.

Nerve damage includes any loss of sensory or motor functions associated with the operation area.

Mortality is defined as the death of a patient due to any cause.

Delirium is defined as a change in consciousness and diagnosed using the DSM-IV criteria.

Anaemia is defined as a blood haemoglobin level < 6.0.

Pressure sores are sores developed postoperatively on specific locations due to a prolonged bedridden condition of the patient.

Pulmonary embolism diagnosis requires CT scan confirmation.

Pneumonia is defined as any respiratory symptoms and confirmed by pulmonary infiltration evident in radiological diagnostics.

Sepsis is defined as postoperative SIRS (≥2 of the following: (1) a body temperature of ≥38 °C or ≤36 °C, (2) a heart-rate of ≥90/min, (3) a respiratory rate of ≥20/min or (4) a white blood cell count of ≥12.000/mm³ or 4.000/mm³ or 10% immature neutrophils).

Deep venous thrombosis diagnosis requires positive ultrasound or phlebography.

Urinary tract infections are defined as infections of the urinary tract confirmed by nitrite test, dipslide or urine culture.

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Title: Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol
Authors: Max P. L. van der Sijp
Inger B. Schipper
Stefan B. Keizer
Pieta Krijnen
Arthur H.P. Niggebrugge
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-017-1724-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol

Abstract

Background

Methods

Discussion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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