Background: Adopting the direct lateral (DL) instead of the posterolateral (PL) approach to thehip for femoral neck fractures (FNF) results in a lower rate of prosthetic dislocation. The aim ofthis study was to compare hip function and complications after hemiarthroplasty (HA) by eitherthe DL or the PL approach for a FNF.
Methods: In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, medianage 84 years) with a displaced FNF. Subjects were, by the surgeons’ preference, assigned totreatment using DL (n=102) or PL approach (n=83) with a HA. Outcomes were Harris hip score(HHS), WOMAC, pain numeric rating scale (PNRS) for pain, limp, mortality and hipcomplications. Patients were followed-up after 1 year.
Results: The HHS was 71 (SD 18) in the DL group and 72 (±17) in the PL group (p=0.59). Wefound no difference in HHS, WOMAC, PNRS and mortality. Seven patients (6.9%) in the DLgroup and 11 patients (13.3%) in the PL group had undergone a major re-operation (adjusted OR0.51; 95% CI, 0.18-2.07; p=0.23). The DL approach was associated with an increased frequencyof patient reported limp (adjusted OR 2.97,1,32-6.67;p=0.008).
Interpretation: In this prospective cohort study, patients treated with HA for FNF using either theDL or PL approaches had comparable functional outcome after 1 year. The PL approach had ahigher re-operation rate while the DL approach had a higher incidence of limp.