title: Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian Arthroplasty Register.
abstract: OBJECTIVE
  Hip dislocation after arthroplasty for femoral neck fractures (FNF) remains a serious complication. The aim of our study was to investigate FNF patients treated with THA, with a special focus of comparing the effect of surgical approach and femoral head size on the risk of revision for dislocation.
  
  
  METHODS
  Data were derived from the Lithuanian Arthroplasty Register, and we calculated the cumulative revision rates after surgery. For survival analysis, we used revision due to dislocation as an end-point. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, femoral head size, surgical approach).
  
  
  RESULTS
  A total of 8,813 primary THAs were registered from 1 January 2011 to 31 December 2013, of which 1,412 were due to FNF: 899 involved 28-mm femoral heads and the remaining 513 received 32-mm heads. The posterior approach was used in 1,156 cases and the anterolateral approach in 256.. At the end of the follow-up period, 74 hips had been revised for recurrent dislocation. Cox regression adjusting for age, gender and head size showed that the posterior approach had 2.3-times [95% confidence interval (CI): 1.0-5.0, p = 0.04] greater risk of revision for dislocation
  
  
  CONCLUSIONS
  We conclude that in order to reduce the early dislocation rate in FNF patients treated with THA, it is more effective to use the anterolateral approach than it is to select a femoral head size of 32 mm instead of 28 mm.
authors.affiliation: Department of Trauma, Klaipeda University Hospital, Klaipeda, Lithuania.
authors.forename: Algimantas
authors.initials: A
authors.lastname: Cebatorius
authors.forename: Otto
authors.initials: O
authors.lastname: Robertsson
authors.forename: Justinas
authors.initials: J
authors.lastname: Stucinskas
authors.forename: Alfredas
authors.initials: A
authors.lastname: Smailys
authors.forename: Linas
authors.initials: L
authors.lastname: Leonas
authors.forename: Sarunas
authors.initials: S
authors.lastname: Tarasevicius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005270:Femur Head / Q000601:surgery*; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008097:Lithuania; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016019:Survival Analysis