title: The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures.
abstract: OBJECTIVE
  Hip replacement is the most common treatment for displaced femoral neck fractures in the elderly, and minimally invasive surgery is popular in the field of orthopaedic surgery. This study evaluated the outcome of monopolar hemiarthroplasty by the direct anterior approach over a postoperative period up to 2.5 years.
  
  
  METHODS
  A total of 86 patients with displaced femoral neck fractures were included (mean age of 86.5 years). Surviving patients were reviewed three months (retrospectively) and one to 2.5 years (prospectively) after surgery. One-year mortality was 36 %.
  
  
  RESULTS
  For all stems, implant positioning with respect to stem alignment, restoration of leg length and femoral offset was correct. Acetabular protrusion was observed in 55 % of the patients one to 2.5 years postoperatively. Subsidence and intraoperative periprosthetic fractures occurred in three patients (3 %) each. All revision stems for postoperative periprosthetic fractures could be implanted using the initial surgical technique without extension of the previous approach. The mean Harris hip score was 85 points at the one to 2.5-year follow-up; 85 % of the patients were satisfied with their hip and 57 % returned to their preoperative level of mobility.
  
  
  CONCLUSIONS
  Based on these findings, hemiarthroplasty for hip fractures can be performed safely and effectively via the direct anterior approach with good functional outcome and high patient satisfaction.
authors.affiliation: Department of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland. schneider.kerstin@gmx.ch
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schneider
authors.forename: Laurent
authors.initials: L
authors.lastname: Audigé
authors.forename: Stefanie-Peggy
authors.initials: SP
authors.lastname: Kuehnel
authors.forename: Naeder
authors.initials: N
authors.lastname: Helmy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000601:surgery*; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function; D015599:Trauma Severity Indices; D016896:Treatment Outcome