Direct Anterior vs. Anterolateral Approach for Hip Arthroplasty After Femoral Neck Fracture in the Senior Population

Displaced femoral neck fractures are one group of hip fracture patients that are commonly
treated with cemented hemiarthroplasty (HA) or total hip arthroplasty (THA). Compared to
those who receive a THA, recipients of HA tend to be less active, more debilitated, and more
dependent on gait aids and the care of others. In this population, the increased stability
and decreased operating time associated with HA is thought to be more important than the
minimal increase in function this population could achieve with THA. Additionally, cemented
femoral stems in HA are thought to result in less pain, increased function, and less
periprosthetic fracture risk when compared to cementless stems.

With the relative pre-injury debility of the femoral neck fracture population, especially
those receiving HA, it is important to optimize all aspects of patient care to allow them to
participate in therapy and return them to their preoperative functional level as quickly as
possible. Furthermore, any intervention in this population should minimize the physiologic
insult of surgery as much as possible. In the elective hip arthroplasty population, the
direct anterior approach (DAA) has shown to be effective in helping patients to quickly
obtain high postoperative function. This approach has also been shown to be effective in
arthroplasty for displaced femoral neck fractures in a few studies. However, the only studies
that directly compare two approaches for hip arthroplasty for femoral neck fractures utilize
the anterolateral approach (ALA) versus posterior approach (PA) or DAA versus PA. No studies
of which we are aware directly compare the DAA to the ALA. The DAA and ALA are the two most
popular approaches for bipolar hemiarthroplasty at our institution, so investigators are
setting out to determine the differences between them.

Inclusion Criteria:

- isolated displaced femoral neck fracture (AO type 31-B2 and 31 B3)

- age≥65 years

- preinjury ambulation with or without a gait aid

- surgical intervention ≤ 48 hours after fracture.

Exclusion Criteria:

- age <65 years

- patients with other fractures or dislocations

- wheelchair bound

- >48 hours between fracture and surgery, presence or history of infection, active
metastatic disease, previous ipsilateral hip prosthesis

- active major psychiatric illness

- active drug or alcohol abuse

- BMI >40, and actively failing contralateral hip prosthesis.