A Retrospective Study on Posterior & Antelateral Approach to Treat Fracture Neck of Femur in Elderly Patients with Non-Cemented Bipolar Prosthesis
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 4, Pages 3289-3294
AbstractIntroduction: There is evidence that cemented hemiarthroplasty improves anchoring and reduces periprosthetic fracture. This surgery, however, causes increased haemodynamic instability and cardiopulmonary problems known as "cement response" or "bone cement implantation syndrome." Surgeons have expressed a strong desire to compare cemented and uncemented hemiarthroplasty for femoral neck fractures. The goal of this study was to compare cemented hemiarthroplasty to uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery, and long-term clinical outcome.
Methods: A retrospective study was conducted on 52 patients who had displaced femoral neck fractures and were treated by the same experienced surgeon with total hip replacement via conventional posterior approach or anterolateral minimally invasive approach. The patients' average age was 78.1 years (range: 65-89 years). They were separated into two groups: anterolateral mini-invasive (30 cases) and posterior (22 cases). The average duration of follow-up was 13 months (range: 6-36 months). Hardinge's anterolateral approach travels through the anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from the anterior capsule. Moore's classic posterior route passes through the insertions of short external rotation muscles to reach the femoral neck from the posterior capsule. The length of incision, operation time, postoperative limp and dislocation rate were the variables under study.
Results: The length of the skin incision using the anterolateral minimally invasive technique varied between 7 cm and 12 cm, compared to 15-22 cm in the standard surgery. When compared to the conventional procedure (87 maximum 10 minimum), the rolateral minimally invasive approach (72 maximum 15 minimum) took less time (average 15 minutes). The average Harris hip score in the anterolateral approach was 91.23 ± 10.20, and 90.03 ± 11.05 with the posterior approach. There were no dislocations in the anterolateral group. One (5%) hip in the posterior approach dislocated.
Conclusions: Anterolateral mini-invasive surgery can reduce trauma, operation time, hospital stay, bed stay, and rehabilitation time. Because of the stability and minimum muscular injury, postoperative rehabilitation can be accelerated, lowering the perioperative risk in the treatment of femoral neck fractures in the elderly having total hip replacement.
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