Reduced revision rate and maintained function after hip arthroplasty for femoral neck fractures after transition from posterolateral to direct lateral approach

Figures & data

Table 1. Study population characteristics

	PL approach (n = 146)	DL approach (n = 216)	p-value
Age, mean (range)	82 (64–99)	83 (61–99)	0.02
Sex, n (%)
Male	44 (30)	64 (30)	1.0
Female	102 (70)	152 (70)
Side, n (%)
Right	63 (43)	112 (52)	0.1
Left	83 (57)	104 (48)
Experience, n (%)
Consultant	113 (77)	130 (60)	0.01
Resident	33 (23)	86 (40)
Arthroplasty, n (%)
HA	99 (68)	191 (88)	0.01
THA	37 (25)	23 (11)
THA with dual mobility cup	10 (7)	2 (1)
ASA, n (%)
1–2	78 (53)	97 (45)	0.2
3–4	68 (47)	116 (54)
SPMSQ, mean (SD)	7 (3.4)	6 (3.7)	0.4
WOMAC, mean (SD)	90.4 (11)	90.6 (12)	0.9
Harris hip score, mean (SD)	84 (13)	83 (14)	0.3
PNRS, mean (SD)	1.4 (1.4)	1.5 (1.4)	0.3

DL = direct lateral approach, PL = posterolateral approach,

HA = Hemiarthroplasty, THA = total hip arthroplasty.

SPMSQ: Short Portable Mental Status Questionnaire

WOMAC: Western Ontario and McMaster Universities Arthritis questionnaires

PNRS: Pain numeric rating scale

SPMSQ, WOMAC, Harris hip score and PNRS presented as baseline measurement.

Table 2. Reoperations presented as number of patients (percentage)

	PL approach (n = 146) (HA =99) (THA =47)	DL approach (n = 216) (HA =191) (THA =25)	Total (n = 362) (HA =290) (THA =72)
Dislocation	7 (5)	3 (1.4)	10 (2.7)
HA	6 (6)	3 (1.6)	9 (3.1)
THA	1 (2)	0	1 (1)
Deep infection	9 (6)	7 (3.2)	16 (4.4)
HA	7 (7)	7 (3.7)	14 (4.8)
THA	2 (4)	0	2 (3)
Periprosthetic fracture	0	2 (0.9)	2 (0.6)
HA	0	2 (1.0)	2 (0.7)
THA	0	0	0
Other reasons	3 (2)	1 (0.5)	4 (1.1)
HA	3 (3)	1 (0.5)	4 (1.4)
THA	0	0	0
Dislocation, recurrent^a	11 (7.5)	3 (1.4)	14 (3.9)
HA	6 (6)	3 (1.6)	9 (3.1)
THA	5 (11)	0	5 (8)

a Including those treated with closed reduction.

For abbreviations, see Table 1

Table 3. Cox proportional hazards presenting unadjusted hazard ratios (HR) for reoperations and recurrent dislocations with 95% confidence interval (CI)

	Reoperation			Dislocation
Variable	HR	CI	p-value	HR	CI	p-value
Surgical approach
DL approach	1.0	–		1.0	–
PL approach	2.2	1.1–4.4	0.03	3.2	1.5–20	0.01
Experience
Resident	1.0	–		1.0	–
Consultant	1.1	0.5–2.2	0.9	1.2	0.4–3.9	0.7
Cognitive dysfunction
No	1.0	–		1.0	–
Yes	1.5	0.7–2.9	0.3	1.8	0.6–5.2	0.3
Arthroplasty
HA	1.0	–		1.0	–
THA	0.5	0.2–1.5	0.2	2.1	0.7–6.4	0.2
Age	1.0	1.0–1.1	0.2	1.0	0.9–1.1	0.6
Sex
Male	1.0	–		1.0	–
Female	1.3	0.6–2.8	0.6	1.6	0.4–5.6	0.5
ASA
1–2	1.0	–		1.0	–
3–4	0.9	0.4–1.7	0.7	1.1	0.5–2.4	0.8

HA = Hemiarthroplasty, THA = total hip arthroplasty

Table 4. Cox proportional hazards presenting adjusted hazard ratios (HR) for reoperations and recurrent dislocation with 95% confidence interval (CI)

	Reoperation			Dislocation
Variable	HR	CI	p-value	HR	CI	p-value
Surgical approach
DL approach	1.0	–		1.0	–
PL approach	2.5	1.2–5.2	0.02	5.4	1.4–20	0.01
Experience
Resident	1.0	–		1.0	–
Consultant	0.9	0.4–1.9	0.8	1.0	0.3–3.1	0.9
Cognitive dysfunction
No	1.0	–		1.0	–
Yes	1.4	0.7–2.9	0.4	3.4	0.9–13	0.07
Arthroplasty
HA	1.0	–		1.0	–
THA	0.6	0.2–2.1	0.4	3.4	0.7–17	0.1
Age	1.0	0.9–1.1	0.6	1.0	0.9–1.1	0.7
Sex
Male	1.0	–		1.0	–
Female	1.2	0.5–2.7	0.7	2.0	0.5–7.7	0.3
ASA
1–2	1.0	–		1.0	–
3–4	0.8	0.4–1.7	0.6	1.0	0.3–3.0	1.0

HA = Hemiarthroplasty, THA = total hip arthroplasty

Table 5. Patient-reported outcome variables: Generalized linear model regression including adjusted variables for Harris hip score (HHS) and WOMAC with 95% confidence interval (CI). Estimated marginal means (EM) for each covariate are included

	Reoperation				Dislocation
Variable	EM	coefficient	CI	p-value	EM	coefficient	CI	p-value
Surgical approach
PL approach	78.8	–	–		71.3	–	–
DL approach	79.9	1.1	–5.7 to 7.6	0.7	72.9	1.6	–3.1 to 6.4	0.5
Experience
Consultant	78.9	–	–		71.7	–	–
Resident	79.8	1.1	–5.7 to 7.9	0.7	72.5	0.8	–4.2 to 5.8	0.8
Cognitive dysfunction
Yes	74.1	–	–		69.5	–	–
No	84.5	10.5	3.9 to 17	≤ 0.01	74.7	5.3	0.3 to 10	0.04
Arthroplasty
THA	79.8	–	–		74.8	–	–
HA	78.8	–0.9	–11 to 9.2	0.9	69.4	–5.3	–13 to 2.2	0.2
Age	80.8	–0.1	0.7 to 0.4	0.6	80.8	–0.08	–0.5 to 0.3	0.7
Sex
Female	80.8	–	–		72.8	–	–
Male	77.8	–2.9	–9.6 to 3.8	0.4	71.4	–1.3	–6.3 to 3.6	0.6
ASA
1–2	80.5	–	–		73.7	–	–
3–4	78.1	–2.4	–3.7 to 8.7	0.4	70.5	–3.2	–1.4 to 7.8	0.2