Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases.

Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients.

Materials and methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs.

Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3-03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation.

Conclusion: Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.