Surgical approaches for arthroplasty in patients with a femoral neck fracture and their short-term surgical complications. A combined Dutch national registries-based study.

Approval date: December 2024

TP Bosch, PB de Witte, P Krijnen, M Gademan, RGHH Nelissen, I Schipper

Research proposal abstract
The incidence of hip fractures is increasing, due to the increasing number of elderly and more patients having comorbidities. It is important to optimize treatment outcomes in this fragile patient population. The lateral, posterolateral, anterolateral and direct anterior approach are all conventional surgical approaches for arthroplasty in femoral neck fractures. Recent literature comparing surgical approaches has indicated differences in treatment outcomes and complications, favoring the direct anterior approach (DAA). However, most of these studies comparing treatment aspects and clinical outcomes of surgical approaches are small retrospective studies on heterogeneous patient populations, with a main focus on THA. The few available larger studies based on national data registries, have only reported on a few clinical outcomes (dislocation, revisions and PROMs) and not all studies compared all conventional approaches. Still, the direct anterior approach (DAA) has recently gained popularity in total hip arthroplasty (THA) placement and to a lesser extent for HHA because of the in the literature reported better clinical outcomes.

The aim of our study is to compare outcomes after the direct anterior approach with those after the posterolateral approach and other approaches (lateral and anterolateral) for hip arthroplasty in femoral neck fracture patients aged 60 years and older. Study outcomes include in-hospital and 3-months surgical complications, length of hospital stay, 3-months return-to-home rate, 3-months mobilisation and 3-months Activities of Daily Living (ADL) scores), revision rate, in-hospital, 3 month and 1-year mortality rate, and preoperatively, 3 and 12 months PROMs.

This study will combine data from two complementary national registries (LROI and DHFA) for analysis, separately for patients with THA and HHA.