title: Abductor Muscle Function and Trochanteric Tenderness After Hemiarthroplasty for Femoral Neck Fracture.
abstract: OBJECTIVE
  To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A secondary teaching hospital.
  
  
  METHODS
  We enrolled 183 hips operated with hemiarthroplasty for displaced femoral neck fracture using the DL or PL approach.
  
  
  METHODS
  Preoperatively, we evaluated the Harris hip score (HHS) and European Quality of Life-5 Dimensions (EQ-5D). At 1 year postoperatively, lucid patients were clinically examined to evaluate the Trendelenburg sign, abductor muscle strength with a dynamometer, and trochanteric tenderness with an electronic algometer. The 1-year HHS and EQ-5D were documented.
  
  
  METHODS
  The primary outcome was the incidence of postoperative Trendelenburg sign, whereas the secondary outcomes included patients' reported limp, abductor muscle strength, trochanteric tenderness, HHS, and EQ-5D.
  
  
  RESULTS
  There were 48 patients (24 in the DL group and 24 in the PL group) who attended the 1-year clinical follow-up. The 2 groups were comparable (P > 0.05). The DL group showed a higher incidence of the Trendelenburg sign (9/24 vs. 1/24, P = 0.02) and limp (12/24 vs. 2/24, P = 0.004). Further analysis with logistic regression showed the surgical approach to be the only factor that resulted in the increment. No differences regarding HHS, EQ-5D, abductor muscle strength, algometer pressure pain threshold, and radiologic measurements were found (P > 0.05).
  
  
  CONCLUSIONS
  The incidence of the Trendelenburg sign and limp were significantly higher in the DL approach although this seemed not to influence abductor muscle strength or the incidence of trochanteric tenderness or compromise the clinical outcome.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), Umeå University, Umeå, Sweden; †Department of Orthopaedics, Danderyd Hospital and Karolinska Institute, Stockholm, Sweden; and ‡Department of Clinical Sciences, Danderyd Hospital (KIDS), Stockholm, Sweden.
authors.forename: Arkan S
authors.initials: AS
authors.lastname: Sayed-Noor
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Hanas
authors.forename: Olof G
authors.initials: OG
authors.lastname: Sköldenberg
authors.forename: Sebastian S
authors.initials: SS
authors.lastname: Mukka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000379:methods; D006784:Hospitals, Teaching; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D016658:Psoas Muscles / Q000503:physiopathology*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013548:Sweden; D016896:Treatment Outcome