Does the Anterior or Posterior Approach to the Hip Provide Superior Functional Recovery After Recovery After Performing Hip Hemiarthroplasty

Background

In patients who sustain a displaced femoral neck fracture, who do not meet criteria for total hip arthroplasty, the recommendations are made for a hemi-arthroplasty of the hip. There are multiple surgical approaches that can be used including the anterior approach to the hip and the posterior approach to the hip. The most widely performed approach to the hip when performing a total hip arthroplasty or hemi-arthroplasty has been the posterior approach. However, multiple approaches exist including posterior approach, direct lateral approach, anterolateral approach and direct anterior approach. There is not a consensus about which approach is the most appropriate or best for patients. The decision for approach is widely decided by the surgeon and is based on experience and preference of the surgeon. Recent advances in the anterior approach to the hip have found improved results with regards to functional status and decreased complications when compared to the posterior approach for total hip arthroplasty. There have been several retrospective studies comparing the anterior vs. posterior approach for hemi-arthroplasty with regards to treatment of femoral neck fractures. These studies have shown conflicting results with regards to which approach is superior. Retrospective studies have shown decreased dislocation rate with the anterior approach, but increased operative time and increased rate of infection with anterior approach as well. To date, there have been two prospective studies performed comparing the anterior and posterior approach for hemi-arthroplasty, one in Japan and one in France, both of which showed decreased dislocation rates but did not display long term functional improvement comparing the two approaches. Both of these studies' patient population and protocol differ greatly from standard of care in the United States. To date, there have been no prospective randomized controlled trials evaluating the functional advantage of the anterior vs. the posterior approach when performing hip hemi-arthroplasty procedure for femoral neck fractures in the United States. It is our hypothesis that the anterior approach will provide superior functional results as a product of the decreased damage to soft tissue and restoration of normal anatomy.

Objectives:

There are several objectives of this study.

The main objective of this study is to evaluate the functional status of each patient using a Harris Hip Score to evaluate both function and pain comparing the anterior vs. the posterior approach for hemi-arthroplasty at 6 months.