Comparison of outcomes in patients undergoing hemiarthroplasty of the hip joint by posterior versus lateral approach

Comparison of outcomes in patients undergoing hemiarthroplasty of the hip joint by posterior versus lateral approach - Aim and Objective: To evaluate the functional outcome in the immediate post- operative period as well as at 4 weeks, 8 weeks, 3 months and 6 months in patients undergoing Hemiarthroplasty using the posterior and lateral approaches and to statistically establish the difference in the mean outcome between the two approaches, if any. Background : Hip fractures are expected to rise from 1.6 million in 2000 to 6.26 million by 2050, posing serious health hazards, especially for the elderly. In elderly persons, low-energy falls resulting from reduced bone density cause the majority of femoral neck fractures; in younger patients, high-energy trauma is usually the cause. Hemiarthroplasty and total hip arthroplasty are the two surgical management options available. The former is recommended due to its speedier recovery time and less traumatic procedure; this is especially important for older patients. The purpose of this research is to evaluate the functional results of hemiarthroplasty patients treated using posterior versus lateral surgical techniques. Materials and Methods: Total 83 patients undergoing Hemiarthroplasty of the hip joint in Dayanand Medical College &Hospital, Ludhiana from 1 January 2021 through 31 March 2022 were evaluated for peri- operative blood loss, operating time, length of hospital stay, as well as evaluated using the HHS in the immediate post-operative period and then at 4 weeks, 8 weeks, 3 months & 6 months and for incidence of complications, to compare the outcome in patients operated using the posterior and lateral approaches. Results : 83 patients were analyzed at final follow-up and majority of the study population was elderly with 90.36% of the patients aged 60 years or above. The study population was almost equally divided between 43 female patients (51.80%) and 40 male patients (48.19%). 32 patients were operated using the lateral approach and 52 patients with the posterior approach. Posterior approach was fared marginally better in terms of intra-operative blood loss, operating time, start of weight bearing, HHS and functional outcome at the final follow-up. Lateral approach was found to be slightly in terms of duration of hospital stay. The difference between both the approaches was not statistically significant for any of the above parameters. Conclusion: Our study found no statistically significant difference between the lateral or posterior approaches for Hemiarthroplasty based on the functional outcomes or incidence of complications, with neither of the approached providing a clear advantage over the other. As a result, it is recommended that the choice of the surgical approach should rather be based on expert opinion based on surgeon preference and experience. Keywords: Hemiarthroplasty, Trauma, Hip joint, Surgical approach, Surgical outcome, Harris Hip Score