title: Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures.
abstract: Adopting the direct lateral (DL) instead of the posterolateral (PL) approach in hip arthroplasty for femoral neck fracture (FNF) patients could lower the rate of prosthetic dislocation. However, little is known about how the approach influences the functional outcome.
  
  
  
  We hypothesized that both approaches would give comparable results.
  
  
  
  In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, median age 84 years) with a displaced FNF. Subjects were assigned to treatment using DL (n=102) or PL approach (n=83) with a hemiarthroplasty (HA). Functional outcome was assessed by Harris Hip Score (HHS), Western Ontario and McMaster Universities Arthritis (WOMAC) index, pain numeric rating scale (PNRS) for pain, mortality and hip complications. Patients were followed-up after 1 year.
  
  
  
  The HHS was 71 (SD 18) in the DL group and 72 (SD 17) in the PL group (P=0.59). We found no difference in WOMAC, PNRS and mortality. Seven patients (6.9%) in the DL group and 11 patients (13.3%) in the PL group had undergone a major reoperation (adjusted OR 0.51; 95% CI, 0.18-2.07; P=0.23).
  
  
  
  In this prospective cohort study, patients treated with HA for FNF using either the DL or PL approaches had comparable functional outcome after 1 year. The PL approach had a tendency towards a higher reoperation rate.
  
  
  
  Prospective cohort study.
  
  
  
  Level 2.
authors.affiliation: Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Mukka
authors.affiliation: Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Mahmood
authors.affiliation: Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Kadum
authors.affiliation: Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Sköldenberg
authors.affiliation: Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden. Electronic address: arkansam@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Sayed-Noor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000379:methods*; D006617:Hip Dislocation / Q000209:etiology; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
keywords: Complications; Direct lateral; Femoral neck fracture; Function; Posterolateral; Surgical approach