Ron Ben ElyahuMeir Medical Center, Israel
Title: Direct anterior vs. direct lateral approach total hip arthroplasty for displaced femoral neck fracture
Background: This study compared outcomes of supine direct anterior approach (DAA) for repairing displaced femoral neck fractures in active older patients and the direct lateral approach (DLA).
Methods: This retrospective study included active older patients who sustained displaced femoral neck fracture and underwent cementless total hip arthroplasty either with a supine DAA or a decubitus DLA. Patients were assessed using the Harris hip score at discharge and at 6-weeks follow-up.
Results: A total of 41 women and 18 men were included, of which 22 were operated with the DLA and 37 with the DAA; all by the same team. In both groups, 69% were women, mean age was 70 years, and mean BMI was 25.2. Mean hemoglobin loss was 2.3g/dl between admission and first post-operative day in both groups. Similar numbers in each cohort were discharged home rather to a rehabilitation center. Patients in the DAA group stayed in the hospital 2 days less compared to the DLA group (4.2±1.9 vs. 6.8±3.7; p<0.001), respectively. Harris hip score in the DAA group was significantly higher at 6 weeks follow-up than in the DLA group (87.23±7.75 vs. 81.23±7.67, respectively; p<0.031).
Conclusion: We found better short-term clinical results for THA done with a DAA compared to a DLA for displaced femoral neck fractures in active older patients. DAA helped patients regain independence faster and might decrease hospitalization and rehabilitation costs. Based on these results, we recommend using the DAA for active older patients with displaced femoral neck fractures.
After graduating from medical school, he began an internship at the Meir Medical Center in Kfar Saba, where he works as a senior physician in the joint replacement team in the orthopedic department. After completing the internship, he underwent a year and a half of training in Italy, in one of the largest joint replacement hospitals in Europe, alongside Prof. Francesco Benatsu, a world-renowned expert in this field. For the past 4 years, he has been part of Prof. Debbie Ronen's surgical team in joint replacement surgery.