Lateral versus posterolateral approach of hemiarthroplasty for fracture neck of femur using bipolar prosthesis

Abstract

Introduction: The purpose of the study is to compare functional outcome, early surgical complications and component alignment between lateral and posterolateral approach of hemiarthroplasty using bipolar prosthesis in fracture neck of femur. Method: Data was collected from 60 patients, who had fracture neck of femur and aged 55 years and above, between the period April 2018 to October 2019, with minimal sample size of 30 in each group. It is a prospective observational study. Aim of the study is to compare the lateral and posterolateral approaches for hemiarthroplasty. Results: In a total pool of 60 patients, the mean age of patients in posterolateral group was 70.97 years while that in the lateral group was 73.03 years. Out of the 60 participants, 25 were male patients while 35 female patients. The mean duration of surgery in posterolateral approach in the cemented group (13 patients) was 73.85 minutes, while in uncemented group (17 patients) was 64.65 minutes. In the lateral approach mean duration of surgery in cemented group (25 patients) was 73.92 minutes while in uncemented (5 patients) was 65.80 minutes. Average blood loss in posterolateral approach group was 254.67 ml and that in the lateral approach group was 263.00 ml. There was no complication of post-operative infection found in either study groups. In our study, leg length discrepancy of >10mm found in 16.7% (n=5) of posterolateral group and 13.3% (n=4) in lateral group and was statistically insignificant. Femoral stem positioning was neutral within both posterolateral and lateral surgical approach groups. There was no posterior dislocation in either approach groups. The mean Harris hip score (HHS) at 6 months in posterolateral group was 71.9 with the lowest score of 38.4 and the highest score of 96.2. The mean HHS at 6 months in the lateral group was 66.75 with the lowest score of 47.6 and the highest of 85. Comparison of the HHS at 6 months between the two groups shows that HHS at 6 months is higher in posterolateral approach group. Conclusion: There is no significant difference between the lateral and posterolateral approaches in the outcomes of duration of surgery, amount of blood loss, early surgical complications, post-operative prosthesis alignment and the functional outcome. In our study it is concluded that the approach used for HA (hip arthroplasty) depends on the preference and training of the surgeon and results of both the approaches are comparable.