Abstract
BACKGROUND
Ideal treatment of displaced femoral neck fragility fractures in the previously ambulatory patient remains controversial. Treating these patients with total hip arthroplasty has improved patient reported outcomes and reduced rates of revision surgery compared to those treated with hemiarthroplasty. However, possible increased risk of dislocation remains a concern with total hip arthroplasty.
The anterolateral and direct anterior approaches to total hip replacement have been applied in the femoral neck fracture population to minimize dislocation rates. However, the anterolateral approach has been associated with abductor injury and increased rates of heterotopic ossification while the anterior approach has been associated with peri-prosthetic femur fracture, lateral femoral cutaneous nerve injury, and wound complications. The Supercapsular Percutaneously Assisted (SuperPATH) approach was developed to minimize disruption of the capsule and short-external rotators in an effort to reduce the risk of dislocation and assist in quicker recovery in the elective hip arthroplasty setting. To achieve this, the SuperPATH technique allows the femur to be prepared in situ and the acetabulum to be reamed percutaneously once the femoral head is removed.
This study investigates the post-operative time to ambulation, length of stay, discharge destination, and early dislocation rate of previously ambulatory patients with a displaced femoral neck fragility fracture that were treated with a total hip arthroplasty via the SuperPATH technique.
METHODS
A retrospective chart review was performed of previously ambulatory patients consecutively treated for a displaced femoral neck fragility fracture with a total hip replacement using the SuperPATH technique. Thirty-five patients were included in the study and examined for demographic data, time to ambulation, length of stay, major and minor complications during their hospital stay. Phone interviews were conducted to check for dislocation events.
RESULTS
Thirty-five patients were included in the study with an average age of 75.7 years old (range 51–95). Patients spent an average of 5.35 ± 1.61 days in the hospital and were discharged on post-operative day 3.6 ±1.38. 89% of patients were able to stand and ambulate by post-operative day 1, and 97% of patients were able to stand and ambulate before discharge from the hospital. 26% of patients were able to be discharged home, 46% were discharged to in-patient rehabilitation, 23% were discharged to a skilled nursing facility, and one patient was discharged to hospice. There were no iatrogenic femoral fractures caused, no incidents of symptomatic heterotopic bone formation, and no superficial or deep wound infections. 88.5% of patients had adequate follow up averaging 370.6 ±235.18 days, with no dislocation events observed.
CONCLUSION
These early results indicate that minimally invasive total hip arthroplasty utilizing the SuperPATH technique is a safe and effective treatment for displaced femoral neck fragility fractures in the previously ambulatory patient. Additionally, this technique allows for early ambulation without an increased risk of dislocation.
