Direct anterior Hueter approach is a safe and effective approach to perform a bipolar hemiarthroplasty for femoral neck fracture

Figures & data

Figure 1. Flowchart of study patients

Table 1. Demographic, clinical, and operative characteristics of the 82 patients

	Direct anterior n = 38	Postero-lateral n = 44	p-value
Demographic and clinical
Age, years	86 (8.8)	85 (7.7)	0.6
Sex, F / M	32 / 6	29 / 15	0.06
BMI	21 (3.6)	23 (3.1)	0.08
ASA score			0.3
1	3	4
2	14	21
3	16	10
NR	5	9
Time from admission to surgery, days	1.6 (1.3)	1.6 (1.4)	0.9
Surgery
Operative time, min	65 (12)	54 (15)	0.005
Drop in hemoglobin (g/dL)	3.0 (3.4)	3.1 (3.9)	0.9
Transfusion required	36%	42%	0.8
Stem size	4.3 (1.6)	4.5 (1.6)	0.7
Head size, mm	45 (3.7)	47 (4.0)	0.2
Neck length (% of standard)	81%	89%	0.7

Data are expressed as mean (SD), number of cases, or percentage.

NR: not rated.

Table 2. Radiographic, clinical, and functional outcomes postoperatively

	Direct anterior n = 38	Postero-lateral n = 44	p-value
Inpatient early outcomes
Pain VAS on fifth postoperative day	2.5 (1.4)	2.8 (1.3)	0.7
Length of stay, days	10 (3.3)	8.7 (4.0)	0.4
Functional outcomes at discharge
Daily analgesic use	19	22	1
Walking ability	33	41	1
Use of 2 cruches or walker	28	25	0.5
Dislocation rate	1	9	0.02
TUG test, seconds			0.06
< 10	0	6
10–19	19	10
20–29	7	16
≥ 30	12	12
Radiographic outcomes
Stem alignment, degrees	0.3 (3.0)	−0.5 (2.1)	0.4
Leg length, mm	6.3 (9.0)	1.4 (8.5)	0.09
Lateral offset, mm	−1.6 (8.5)	4.2 (6.4)	0.04

Data are expressed as mean (SD) or number of cases.

Table 3. Outcomes at latest follow-up

	Direct anterior n = 38	Postero-lateral n = 44	p-value
Time to intervention, months	22 (5.1)	21 (5.1)	0.9 ^a
Patient survivorship	29	33	1 ^b
BHA prosthesis survivorship	35	42	1 ^b
Late functional status
Walking ability	30	37	1 ^b
Use of cane or walker	19	25	0.8 ^b
Global hip pain	8	13	0.5 ^b
PMA score
Pain	5.6 (1.1)	4.9 (1.4)	0.03 ^a
Function	3.6 (2.3)	3.4 (2.1)	0.7 ^a
Mobility	4.7 (1.3)	5.3 (0.5)	0.07 ^a
Total	14 (3.3)	14 (3.2)	0.6 ^a

Data are expressed as mean (SD) or number of cases.

^a Mann-Whitney test.

^b Fisher’s exact test.

Table 4. Studies comparing the direct anterior (DA) and posterolateral (PL) approaches

Reference	Type	n	Randomized	Duration of follow-up	Primary outcome	Dislocation rates
Nakata et al. (2009)	THA	195	no	6 months ^a	Functional tests
Martin et al. (2012)	THA	88	no	6 months ^a	Early moribidity	1/41 (DA) vs. 3/47 (PL)
Barrett et al. (2013)	THA	87	yes	1 year	Walking ability	0/43 (DA) vs. 1/44 (PL)
Baba et al. (2013)	BHA	79	yes	3 years	Walking ability	0/40 (DA) vs. 1/39 (PL)
Current study	BHA	82	yes	6 weeks / 21 months	TUG test	1/38 (DA) vs. 9/44 (PL)

^a Retrospective; THA: total hip arthroplasty; BHA: bipolar hemiarthroplasty.

Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 2009; 24(5): 698-704.

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Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 2013; 28(9): 1634-8.

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Baba T, Shitoto K, Kaneko K. Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 2013; 4(2): 85-9.

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