EARLY EFFECTIVENESS COMPARISON OF HEMIARTHROPLASTY BY MINIMAL INVASIVE Supercap APPROACH AND BY CONVENTIONAL APPROACH FOR ELDERLY FEMORAL NECK FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 JIAXiaolin , ZHOUMingquan , HUWei , GANQiang

Department of Orthopedics, Chongqing People's Hospital, Chongqing, 400013, P.R.China;

Corresponding author：

JIAXiaolin, Email: jiaxlin@163.com

Keywords：

Minimally invasive surgery; Hemiarthroplasty; Elderly; Femoral neck fracture

DOI：

10.7507/1002-1892.20160273

Video：

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Objective To compare the early clinical and radiographic outcomes of hemiarthroplasty by a minimal invasive Supercap approach and by a conventional approach for elderly displaced femoral neck fractures. Methods Between January and June 2015, 70 geriatric patients with displaced femoral neck fracture underwent cementless bipolar hemiarthroplasty by minimally invasive Supercap approach (group A, n=35) or by posterolateral approach (group B, n=35). One patient was excluded from the study in group B because of too wide femur cavity. There was no significant difference in gender, age, body mass index, fracture cause, time from fracture to operation, fracture side, fracture classification, and preoperative visual analogue scale (VAS), and hemoglobin-level between the 2 groups (P > 0.05). The operation time, intraoperative blood loss, incision length, and complications were recorded. The early clinical evaluations included timed up and go test (TUG), hemoglobin-level, VAS score, and satisfaction. The anteroposterior and lateral X-ray films were taken to measure the stem alignment, difference in leg length, and difference in femoral offset. Results All the patients were followed up 6-11 months (mean, 7.32 months). No patients died during follow-up. There was no significant difference in operation time and intraoperative blood loss between the 2 groups (P > 0.05). The incision length of group A was significantly smaller than that of group B (P < 0.05). One patient had delayed union of incision in group A (2.86%); 2 patients had deep vein thrombosis in group B (5.88%); and there was no significant difference in the complication rate (χ²=0.764, P=0.512). The postoperative hemoglobin level showed no significant difference between the 2 groups (P > 0.05). Group A had lower VAS score and higher subjective satisfaction than group B, showing significant difference at 1, 5, and 14 days after operation (P < 0.05). The TUG of group A was significantly shorter than that of group B at 5, 14, and 30 days (P < 0.05). There was no significant difference in femoral offset or leg length on the X-ray films (t=1.273, P=0.851; t=0.409, P=0.327). The good rate of stem alignment was 82.86% (29/35) in group A, and was 85.30% (29/34) in group B, showing no significant difference (χ²=0.584, P=0.497). Conclusion Both minimal invasive Supercap approach and conventional posterolateral approach are effective and safe for elderly displaced femoral neck fractures in hemiarthroplasty. Supercap approach has the advantages of less trauma, pain relief, and improvement of mobility and rapid rehabilitation.

Citation： JIAXiaolin, ZHOUMingquan, HUWei, GANQiang. EARLY EFFECTIVENESS COMPARISON OF HEMIARTHROPLASTY BY MINIMAL INVASIVE Supercap APPROACH AND BY CONVENTIONAL APPROACH FOR ELDERLY FEMORAL NECK FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1331-1337. doi: 10.7507/1002-1892.20160273 Copy

1.	Kannan A, Kancherla R, McMahon S, et al. Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop, 2012, 36(1): 1-8.
2.	Murphy DK, Randell T, Brennan KL, et al. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res, 2013, 471(8): 2691-2702.
3.	Cheng T, Feng JG, Liu T, et al. Minimally invasive total hip arthroplasty: a systematic review. Int Orthop, 2009, 33(6): 1473-1481.
4.	Schneider K, Audigé L, Kuehnel SP, et al. The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures. Int Orthop, 2012, 36(9): 1773-1781.
5.	Murphy SB. Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy. Operative Techniques in Orthopaedics, 2004, 14(2): 94-101.
6.	Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991, 39(2): 142-148.
7.	Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.
8.	Rottinger H. Minimally invasive anterolateral surgical approach for total hip arthroplasty: early clinical results. Hip Int, 2006, 16 Suppl 4: 42-47.
9.	Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty, 2009, 24(5): 698-704.
10.	Chow J, Penenberg B, Murphy S. Modified micro-superior percutaneously-assisted total hip: early experiences & case reports. Curr Rev Musculoskelet Med, 2011, 4(3): 146-150.
11.	Moskal JT, Capps SG. Is limited incision better than standard total hip arthroplasty? A meta-analysis. Clin Orthop Relat Res, 2013, 471(4): 1283-1294.
12.	Golec J, Rozek K, Kazana M. Assesment scores of functional efficiency in hip osteoathritis. Ortop Traumatol Rehabil, 2010, 12(3): 273-277.
13.	Williams DH, Greidanus NV, Masri BA, et al. Predictors of participation in sports after hip and knee arthroplasty. Clin Orthop Relat Res, 2012, 470(2): 555-561.
14.	Laflamme GY, Rouleau DM, Leduc S, et al. The timed up and go test is an early predictor of functional outcome after hemiarthroplasty for femoral neck fracture. J Bone Joint Surg (Am), 2012, 94(13): 1175-1179.
15.	Rahman WA, Greidanus NV, Siegmeth A, et al. Patients report improvement in quality of life and satisfaction after hip resurfacing arthroplasty. Clin Orthop Relat Res, 2013, 471(2): 444-453.
16.	Abe H, Sakai T, Takao M, et al. Difference in stem alignment between the direct anterior approach and the posterolateral approach in total hip arthroplasty. J Arthroplasty, 2015, 30(10): 1761-1766.
17.	Innmann MM, Streit MR, Kolb J, et al. Influence of surgical approach on component positioning in primary total hip arthroplasty. BMC Musculoskelet Disord, 2015, 16: 180.
18.	Alecci V, Valente M, Crucil M, et al. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol, 2011, 12(3): 123-129.

1. Kannan A, Kancherla R, McMahon S, et al. Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop, 2012, 36(1): 1-8.
2. Murphy DK, Randell T, Brennan KL, et al. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res, 2013, 471(8): 2691-2702.
3. Cheng T, Feng JG, Liu T, et al. Minimally invasive total hip arthroplasty: a systematic review. Int Orthop, 2009, 33(6): 1473-1481.
4. Schneider K, Audigé L, Kuehnel SP, et al. The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures. Int Orthop, 2012, 36(9): 1773-1781.
5. Murphy SB. Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy. Operative Techniques in Orthopaedics, 2004, 14(2): 94-101.
6. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991, 39(2): 142-148.
7. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.
8. Rottinger H. Minimally invasive anterolateral surgical approach for total hip arthroplasty: early clinical results. Hip Int, 2006, 16 Suppl 4: 42-47.
9. Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty, 2009, 24(5): 698-704.
10. Chow J, Penenberg B, Murphy S. Modified micro-superior percutaneously-assisted total hip: early experiences & case reports. Curr Rev Musculoskelet Med, 2011, 4(3): 146-150.
11. Moskal JT, Capps SG. Is limited incision better than standard total hip arthroplasty? A meta-analysis. Clin Orthop Relat Res, 2013, 471(4): 1283-1294.
12. Golec J, Rozek K, Kazana M. Assesment scores of functional efficiency in hip osteoathritis. Ortop Traumatol Rehabil, 2010, 12(3): 273-277.
13. Williams DH, Greidanus NV, Masri BA, et al. Predictors of participation in sports after hip and knee arthroplasty. Clin Orthop Relat Res, 2012, 470(2): 555-561.
14. Laflamme GY, Rouleau DM, Leduc S, et al. The timed up and go test is an early predictor of functional outcome after hemiarthroplasty for femoral neck fracture. J Bone Joint Surg (Am), 2012, 94(13): 1175-1179.
15. Rahman WA, Greidanus NV, Siegmeth A, et al. Patients report improvement in quality of life and satisfaction after hip resurfacing arthroplasty. Clin Orthop Relat Res, 2013, 471(2): 444-453.
16. Abe H, Sakai T, Takao M, et al. Difference in stem alignment between the direct anterior approach and the posterolateral approach in total hip arthroplasty. J Arthroplasty, 2015, 30(10): 1761-1766.
17. Innmann MM, Streit MR, Kolb J, et al. Influence of surgical approach on component positioning in primary total hip arthroplasty. BMC Musculoskelet Disord, 2015, 16: 180.
18. Alecci V, Valente M, Crucil M, et al. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol, 2011, 12(3): 123-129.

Chinese Journal of Reparative and Reconstructive Surgery

EARLY EFFECTIVENESS COMPARISON OF HEMIARTHROPLASTY BY MINIMAL INVASIVE Supercap APPROACH AND BY CONVENTIONAL APPROACH FOR ELDERLY FEMORAL NECK FRACTURE

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