Direct anterior approach for femoral neck fractures – 10-year results

Introduction

While the Direct Anterior Approach (DAA) is established for coxarthrosis treatment, its application in femoral neck fracture (FNF) is rarely documented. Common approaches are anterolateral (ALL) and transgluteal (TG).

Material&Methods

This 10-year retrospective analysis covers 1476 FNF patients (31B1-B3) treated from 2011 to 2021 at our department, 879 received arthroplasty via DAA.

Results

Approximately 75% received DAA hip arthroplasty, increasing to 95% since 2016 (Fig 1). 81.2% were female, with an average age of 83 ± 9 years. DAA patients required fewer blood transfusions (DAA: 25.4%, ALL: 43.7%, TG: 30.6%, p<0.001). Mortality rates were similar (5%, p=0.748). Patients < 70 years treated with DAA experienced earlier discharges (7 days ± 7 days, p<0.013) and improved mobilization.

Surgical approach did not affect operation duration (p=0.114). DAA patients had the lowest early infection rate (DAA: 2.7%, ALL: 5.7%, TG: 8.3%), with fewer revision surgeries needed.

An alternative approach (ALL/TG) was used in 0.9% due to factors like obesity, intertrigo or pre-existing amputation, preventing extension frame use (Fig 2). The incidence of N. cutaneus femoris lateralis affection was 0,3%, its assessement in geriatric patients was challenging; the actual rate might be higher.

Conclusion

The DAA is a safe and cost-effective method for the management of FNF, with its benefits in improved postoperative mobilization and reduced blood loss, without increasing infection and complication risks.

References

Z. M. Elstad, et al., "Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures," Arthroplasty Today 2021

Y. M. den Hartog, et al., "Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures," Acta Orthop

C. Edwards, et al., "Early infection after hip fracture surgery: risk factors, costs, and outcome," J. Bone Joint Surg. Br., 2008

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