Key result
The direct anterior approach for bipolar hemiarthroplasty initially required more operative time than the posterolateral approach (79.8 vs 73.6 minutes) but resulted in significantly less blood loss (318.1 vs 380.8 mL).
Why the study?
To compare short-term results between the direct anterior approach and the conventional posterolateral approach for bipolar hemiarthroplasty in elderly patients with femoral intertrochanteric fractures.
Does the direct anterior approach improve surgical outcomes compared to the posterolateral approach in elderly patients undergoing bipolar hemiarthroplasty for intertrochanteric fractures?
Cohort (n=100)
No
Does the direct anterior approach improve surgical outcomes compared to the posterolateral approach in elderly patients undergoing bipolar hemiarthroplasty for intertrochanteric fractures?
Absolute Event Rate: 79.8% vs 73.6%
p-value: p=0.013
The direct anterior approach is a safe, muscle-preserving alternative to the posterolateral approach for bipolar hemiarthroplasty in elderly patients with intertrochanteric fractures, offering reduced blood loss and comparable operative times after a short learning curve.
DAA shows similar short-term safety and less blood loss than PLA in this retrospective series; leaves open whether it improves outcomes in intertrochanteric fracture hemiarthroplasty.
Purpose: The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients. Materials and Methods:A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted.The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021.Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed.And the incidence of complications was examined.Results: Operative time was 73.60± ±14.56 minutes in the PLA group and 79.80± ±8.89 minutes in the DAA group (P<0.05).However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (P=0.331).Blood loss was 380.76± ±180.67 mL in the PLA group and 318.14± ± 138.51 mL in the DAA group (P<0.05).The hospitalization was 23.76± ±11.89 days in the PLA group and 21.45 ± ±4.18 days in the DAA group (P=0.207).In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group.Conclusion: Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.
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Chung et al. (2023) conducted a cohort in Femoral intertrochanteric fractures (n=100). Direct anterior approach (DAA) vs. Conventional posterolateral approach (PLA) was evaluated on Mean operative time (minutes) (p=0.013). The direct anterior approach for bipolar hemiarthroplasty initially required more operative time than the posterolateral approach (79.8 vs 73.6 minutes) but resulted in significantly less blood loss (318.1 vs 380.8 mL).
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