title: Treatment of femoral neck fracture with a minimal invasive surgical approach for hemiarthroplasty - clinical and radiological results in 180 geriatric patients.
abstract: OBJECTIVE
  The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH.
  
  
  METHODS
  The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery.
  
  
  RESULTS
  After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length.
  
  
  CONCLUSIONS
  Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible.
authors.affiliation: University Hospital Schleswig Holstein, Campus Luebeck, Department of Traumatology, Ratzeburger, Allee 160, 23538 Luebeck, Germany.
authors.forename: A C
authors.initials: AC
authors.lastname: Unger
authors.affiliation: University Hospital Schleswig Holstein, Campus Luebeck, Department of Traumatology, Ratzeburger, Allee 160, 23538 Luebeck, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Dirksen
authors.affiliation: University Hospital Schleswig Holstein, Campus Luebeck, Department of Traumatology, Ratzeburger, Allee 160, 23538 Luebeck, Germany.
authors.forename: F G
authors.initials: FG
authors.lastname: Renken
authors.affiliation: University Hospital Schleswig Holstein, Campus Luebeck, Department of Traumatology, Ratzeburger, Allee 160, 23538 Luebeck, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Wilde
authors.affiliation: Red Cross Hospital - Department for Geriatric Rehabilitation, Marlistr. 10, 23568 Luebeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Willkomm
authors.affiliation: University Hospital Schleswig Holstein, Campus Luebeck, Department of Traumatology, Ratzeburger, Allee 160, 23538 Luebeck, Germany.
authors.forename: A P
authors.initials: AP
authors.lastname: Schulz
keywords: Bipolar hip hemiarthroplasty; femoral neck fracture; geriatrics; minimal invasive surgery.