Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing from posterolateral to anterolateral approach

• Published in: Acta orthopaedica Vol. 81; no. 5; pp. 583 - 587
• Main Authors: Sköldenberg, Olof, Ekman, Anna, Salemyr, Mats, Bodén, Henrik
• Format: Journal Article
• Language: English
• Published: England Nordic Orthopaedic Federation 01-10-2010
• Subjects: Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Cohort Studies; Female; Femoral Neck Fractures - surgery; Hip Dislocation - etiology; Hip Dislocation - surgery; Hip Prosthesis - adverse effects; Humans; Male; Medicin och hälsovetenskap; Prospective Studies; Prosthesis Failure; Reoperation; Risk Factors
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.3109/17453674.2010.519170

Background and purpose Recent studies have shown that compared to the posterolateral approach, the anterolateral approach reduces the risk of dislocation after hip arthroplasty in patients with femoral neck fractures. We have therefore started to use the anterolateral approach on these patients and we now report the consequences of this change for the dislocation rate.
Patients and methods We chose two 1-year time periods, 2007 (n = 199) and 2008 (n = 173), the former being before and the latter after the implementation of the anterolateral approach as the standard incision for hip arthroplasties in patients with femoral neck fractures. During 2007, 77% of the hips were operated on with the posterolateral approach and in 2008, 78% of the hips were operated on using the anterolateral approach.
Results The dislocation rate was reduced from 8% (16/199) in 2007 to 2% (3/173) in 2008. A multivariable logistic regression analysis showed that the posterolateral approach was the only factor associated with an increased risk of dislocation, with an odds ratio of 8 (2-35). Age, sex, ASA classification, type of arthroplasty, cognitive dysfunction, or the experience of the surgeon had no effect on the risk of dislocation.
Interpretation Since most of our surgeons had earlier used the posterolateral approach when performing hip arthroplasties in patients with a femoral neck fracture, this study shows our surgical learning curve. We conclude that a collective policy change regarding surgical approach for these patients is both feasible and to be recommended, as it leads to a substantial reduction in dislocation rate.