Anterior Versus Posterior Approach for Total Hip Arthroplasty in Femoral Neck Fractures

Background

The purpose of this study was to compare complication rates and clinical outcomes at 1 year or until death based on the surgical approach for total hip replacement in femoral neck fractures.

Methods

This retrospective study was performed on 101 patients with displaced femoral neck fractures at our institution between 2005 and 2022. All surgeries were performed by fellowship-trained arthroplasty surgeons via either a posterior Kocher-Langenbeck approach, an abductor sparing anterolateral approach, or a direct anterior approach. Demographics were collected, as well as intraoperative characteristics, discharge information, and complications.

Results

Thirty-seven patients underwent a direct anterior approach, 42 underwent an abductor sparing anterolateral approach, and 22 underwent a posterior approach, with no significant difference in demographics between the groups. Of patients, 43.3% were able to be discharged home, while 55.4% of patients went to subacute rehab or other nursing home facility. There was a 30.6% complication rate, a 7% reoperation rate, and a 0.9% dislocation rate. The posterior group was more likely to be discharged to rehab instead of home (82.0% compared to 48.6%, P = .0054) and had a significant increase in complication rate (P = .04). There was a 36.3% rate of transfusion in the posterior group compared to a 5.0% rate in the anterior group (P < .0001).

Conclusions

Anterior-based total hip arthroplasty for femoral neck fractures in our series demonstrated a significantly lower rate of postoperative complications, a lower rate of transfusion, and a significantly higher rate of being discharged home.

Level of Evidence

Level III.