Early functional outcome between Moore and Modified Hardinge approach in hemi-replacement hip arthroplasty – A Prospective Interventional Study.
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 7, Pages 634-645
AbstractIntroduction: Hemiarthroplasty is a common treatment for patient with a fragility displaced femoral neck fracture. The surgical approach used for hemiarthroplasty is expected to affect the treatment outcomes, in terms of dislocations, performance in daily activities, quality of life after the procedure and the learning curve for surgeons. However, little is known about how the approaches influences the functional outcome following hemi arthroplasty. We hypothesized that both approaches would give comparable results.
Aim : To assess the overall functional outcome in patients undergoing hemi replacement hip arthroplasty using Moore’s approach and modified Hardinge approach.
Material and methods: In a prospective interventional study between January 2020 to June 2021 which included 43 hips with a displaced Fracture Neck of Femur at RajaRajeswari medical college and hospital, Bangalore. Sample size was calculated using formula n=Z2*(SD)2/L2. Subjects were assigned to treatment groups using simple random sampling technique. Intra-operative and immediate post-operative parameters was entered in MS EXCEL spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. The student’s t-test was used for normally distributed data and the Mann-Whitney U test for ordinal data. The chi-squared test or Fisher’s exact test were used for nominal data. Patients were followed up for a duration of 6months post-operatively. Functional outcome was assessed by Harris Hip Score (HHS).
Results: The mean age was 70.46 years and 31 (72.09%) patients had left sided hip involvement. Mean operating time was significantly more in the Modified Hardinge’s group (112 minutes) compared to the Moore’s group (91.30minutes). Length of incision and amount of blood loss was significantly high in Moore’s approach (p <0.001). Two patients (8.6%) had posterior dislocation of hip postoperative and one patient (4.3 %) had superficial surgical site infection in Moore’s group. Mean Harris Hip score at 6weeks (65.42 ± 5.70, 70.68 ± 4.81, p value <0.03) and 3 months (71.21 ± 5.57, 76.35 ± 5.25, p value <0.004) follow-up was significantly higher in Modified Hardinge’s Group and 6 months (84.31 ± 6.19, 85.9 ± 2.55, p value >0.05) did not show any significant difference between the two groups.
Conclusion: Adopting the Modified Hardinge’s approach instead of the posterior approach in hip hemi arthroplasty for femoral neck fracture patients could lower the rate of complications
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