Comparison of Dislocation and Outcome Between Piriformis-Sparing and Conventional Posterior Approach After Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients Over 60 Years |
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| Institution: | 1. Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;2. Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand;3. Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand;1. Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina;2. Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida;3. Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania;4. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana;1. Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California;2. Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada;3. Corin Group, The Corinium Centre, Cirencester, Gloucestershire;4. Division of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany;5. Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York;6. Melbourne Orthopaedic Group, Melbourne, Australia;1. Department of Biomechanics, Hospital for Special Surgery, New York, New York;2. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York;1. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York;2. Weill Cornell Medicine, Cornell University, New York, New York |
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| Abstract: | BackgroundHemiarthroplasty is a treatment option for femoral neck fractures in patients aged more than 60 years and postoperative dislocation after a posterior approach is not uncommon. The piriformis tendon is one of the structures providing posterior hip stability. However, evidence of piriformis-sparing approach in hemiarthroplasty is unclear regarding a reduced dislocation rate.MethodsBetween January 2017 and December 2019, 321 patients underwent a posterior approach in consecutive cohorts for a hemiarthroplasty for femoral neck fractures with the minimum 24 months follow-up time (24-60 months). There were two cohorts: (1) 129 underwent the conventional posterior (CP) approach and (2) 192 underwent the piriformis-sparing (PS) approach. The differences in dislocation rate, postoperative Harris Hip Society at 1 and 2 years and other surgical complications were compared in both groups.ResultsThere were 6 dislocations of 129 (4.7%) underwent the CP approach and 0 dislocation from 192 underwent the PS approach that had posterior hip dislocations (P = .004). In addition, the CP group had a significantly higher mortality rate (14.7% versus 7.3%, P = .031) and lower functional outcomes as assessed by mean Harris Hip Scores at 1 year (73 versus 78, P = .005) and 2 years postoperatively (73 versus 80, P < .001) relative to the PS group.ConclusionPS hemiarthroplasty was associated with a lower dislocation and mortality rate. Moreover, this approach gained a superior early to the mid-term functional outcome than the conventional posterior approach in elderly femoral neck fractures.Level of EvidenceII, prospective cohort study. |
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| Keywords: | piriformis-sparing conventional posterior dislocation outcome hip hemiarthroplasty |
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