title: Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases.
abstract: OBJECTIVE
  Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches.
  
  
  METHODS
  We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia stem with self-centring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test.
  
  
  RESULTS
  After a dorsal approach 10.5 % [confidence interval (CI) 7.7-13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7-13.6 %), which was not significantly different (p = 0.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2-5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0-1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5-8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2-2.2 %). The frequency of the other types of complications did not significantly differ.
  
  
  CONCLUSIONS
  The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Klinikum Nuernberg, Breslauer Str. 201, 90471 Nuremberg, Germany. biber@klinikum-nuernberg.de
authors.forename: Roland
authors.initials: R
authors.lastname: Biber
authors.forename: Matthias
authors.initials: M
authors.lastname: Brem
authors.forename: Katrin
authors.initials: K
authors.lastname: Singler
authors.forename: Manfred
authors.initials: M
authors.lastname: Moellers
authors.forename: Cornel
authors.initials: C
authors.lastname: Sieber
authors.forename: Hermann Josef
authors.initials: HJ
authors.lastname: Bail
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D017760:Bone Malalignment / Q000453:epidemiology / Q000209:etiology; D002484:Cementation; D005260:Female; D005265:Femoral Neck Fractures / Q000503:physiopathology / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000379:methods*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome