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Logo of bmcmudisBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Musculoskeletal Disorders
BMC Musculoskelet Disord. 2012; 13: 141.
Published online Aug 8, 2012. doi:  10.1186/1471-2474-13-141
PMCID: PMC3488324
Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach
Felix Renken,1 Svenja Renken,2 Andreas Paech,1 Michael Wenzl,3 Andreas Unger,1 and Arndt P Schulzcorresponding author1,4
1University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, D 23538, Lübeck, Germany
2University Lübeck, Medical Faculty, Lübeck, Germany
3Klinikum Ingolstadt, Ingolstadt, Germany
4BG Trauma Hospital Hamburg, Bergedorfer Strasse, Hamburg, Germany
corresponding authorCorresponding author.
Felix Renken: felix.renken/at/; Svenja Renken: info/at/; Andreas Paech: Andreas.Paech/at/; Michael Wenzl: MEWENZL/at/; Andreas Unger: ungandreas/at/; Arndt P Schulz: schulz/at/
Received November 9, 2011; Accepted July 2, 2012.
A minimal invasive approach for elective hip surgery has been implemented in our institution in the past. It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery. Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma.
Sixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, the so called “direct anterior approach” (DAA) was chosen, in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty.
Primary outcome parameter was the mobility as measured by the four-item-Barthel index. Secondary outcome parameters included pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. Radiographs were evaluated.
A statistically significant difference (p = 0,009) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS) showed a statistically significant difference (p = 0,035) at day 16. No difference was evident in the comparison of radiographic results.
Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. There is no radiographic evidence that a minimal invasive technique leads to inferior implant position.
Level of Evidence: Level II therapeutic study.
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