Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach

Introduction

Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.

Hypothesis

Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.

Material and methods

This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative “hidden” blood loss. The risk of early dislocation (less than 6 months) was also analyzed.

Results

Total blood loss was similar between the two groups, AA: 1626 ± 506 mL versus PA: 1746 ± 692 mL (p = 0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p = 0.31) as well as the duration of hospitalization, AA: 8.5 ± 3.2 versus PA: 8.2 ± 3.3 days (p = 0.54). The operating time was shorter in the PA group (Δ = 10.3 ± 14.1 minutes [p < 0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p = 0.03).

Conclusion

This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.

Level of proof

III, comparative study of continuous series.