Does the Choice of Approach for Hip Hemiarthroplasty in Geriatric Patients Significantly Influence Early Postoperative Outcomes? A Randomized-Controlled Trial Comparing the Modified Smith-Petersen and Hardinge Approaches

Abstract

Minimally invasive surgical approaches for total hip replacement, such as the modified Smith-Petersen approach, have been reported to be advantageous over alternative techniques because of reduced soft tissue damage and improved immediate postoperative rehabilitation. This study compares the advantages of the Smith-Petersen approach against the lateral Hardinge approach for femoral neck fractures in geriatric patients. In a randomized-controlled trial, 48 patients were treated by a hemiarthroplasty of the hip using either a modified Smith-Petersen or a Hardinge approach. Age, American Society of Anesthesiologists score, body mass index, blood loss, pain, and postoperative mobilization were compared between groups to detect statistically significant differences. The same outcome measures were analyzed for significant differences between patients with or without complications in each group. The Smith-Petersen approach yielded a statistically significant increase in postoperative pain within the first 4 days and an increase in operation time. Complications were also associated with a significantly higher intraoperative time in the same group. However, 6 months postoperatively, there were no significant differences in the Harris Hip score between groups. Despite early postoperative differences, postoperative mobility does not seem to be greatly influenced by the choice of either an anterior modified Smith-Petersen or a lateral Hardinge approach for hip hemiarthroplasty. Operative time was significantly linked to postoperative complications. In this respect, it can be concluded that it is not be the approach itself that determines the early postoperative result, but the routine the individual surgeon has with it.