title: Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach.
abstract: BACKGROUND
  A minimal invasive approach for elective hip surgery has been implemented in our institution in the past. It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery. Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma.
  
  
  METHODS
  Sixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, the so called "direct anterior approach" (DAA) was chosen, in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty.Primary outcome parameter was the mobility as measured by the four-item-Barthel index. Secondary outcome parameters included pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. Radiographs were evaluated.
  
  
  RESULTS
  A statistically significant difference (p = 0,009) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS) showed a statistically significant difference (p = 0,035) at day 16. No difference was evident in the comparison of radiographic results.
  
  
  CONCLUSIONS
  Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. There is no radiographic evidence that a minimal invasive technique leads to inferior implant position.
  
  
  METHODS
  Level II therapeutic study.
authors.affiliation: University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, D 23538, Lübeck, Germany. schulz@biomechatronics.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Renken
authors.forename: Svenja
authors.initials: S
authors.lastname: Renken
authors.forename: Andreas
authors.initials: A
authors.lastname: Paech
authors.forename: Michael
authors.initials: M
authors.lastname: Wenzl
authors.forename: Andreas
authors.initials: A
authors.lastname: Unger
authors.forename: Arndt P
authors.initials: AP
authors.lastname: Schulz
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017102:Fracture Healing; D005858:Germany; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000379:methods*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D051346:Mobility Limitation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome