Posterolateral and direct lateral approach for cemented hemiarthroplasty equally successful in acute femoral neck fracture

A recent study published in the Journal of American Medical Association suggests that posterolateral approach (PLA) for cemented hemiarthroplasty in older adults with acute femoral neck fractures was closely associated with significantly more dislocations and reoperations than direct lateral approach (DLA).

This multicenter trial conducted across 14 medical facilities in the Netherlands encompassed both randomized clinical trial (RCT) and natural experiment (NE) and focused on the PLA and DLA to uncover insights crucial for improving hip fracture care.

The study spanned from February 2018 to January 2022 and included 843 patients aged 18 or older, with acute femoral neck fractures. The patients with secondary hip surgeries, pathological fractures, or multitrauma were excluded. The primary focus was on health-related quality of life six months after surgery. The secondary outcomes included dislocations, fear of falling, activities of daily living, pain, and reoperations.

The results were analyzed from July to September 2022 and indicated no statistically significant or clinically meaningful difference in the quality of life between the two surgical approaches. The posterolateral approach was associated with a higher rate of dislocations and reoperations compared to the direct lateral approach.

The study found that, among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, the posterolateral approach did not offer a superior quality of life compared to the direct lateral approach. Also, higher concerns regarding increased rates of dislocations and reoperations after the posterolateral approach were observed.

Reference:

Tol, M. C. J. M., Willigenburg, N. W., Rasker, A. J., Willems, H. C., Gosens, T., Heetveld, M. J., Schotanus, M. G. M., Eggen, B., Kormos, M., van der Pas, S. L., van der Vaart, A. W., Goslings, J. C., Poolman, R. W., van Roon, F., van Dijk, M., Keizer, J., Vochteloo, A. J. H., Joosse, P., … Boonen, B. (2024). Posterolateral or Direct Lateral Surgical Approach for Hemiarthroplasty After a Hip Fracture. In JAMA Network Open (Vol. 7, Issue 1, p. e2350765). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.50765