A novel no hip extension method during bipolar hip hemiarthroplasty using direct anterior approach for treatment of geriatric displaced femoral neck fracture.

BACKGROUND: The optimal approach to treat geriatric displaced femoral neck fracture (DFNF) during bipolar hip hemiarthroplasty (BHH) is still unclear. A novel technique of no hip extension during total hip arthroplasty using direct anterior approach (DAA) has been used recently. This study aimed to evaluate the clinical and radiographic outcomes of BHH through DAA using a novel no hip extension for DFNF. METHODS: A total of 66 patients of cement BHH between October 2019 to December 2022 using no hip extension method during BHH through DAA for treatment of DFNF were reviewed. The patients who underwent BHH using DAA with no hip extension comprising the DAA group were matched 1:2 with patients who underwent BHH using direct lateral approach (DLA) comprising the DLA group. The demographics was collected, clinical results were assessed using the visual analogue scale (VAS) and Modified Barthel scores, mobilisation, and complications. Femoral offset, leg length discrepancy (LLD), stem alignment (varus, neutral and vulgus) and heterotopic ossification (HO) were evaluated radiologically. RESULTS: The postoperative outcomes of the Modified Barthel and VAS scores, and mobilisation were better in the DAA groups one month after surgery, there were significant differences between DAA and DLA groups (p < 0.05). Thereafter, those differences were not statistically significant (p > 0.05). Comparing to DLA group, similar radiographic outcomes were achieved in the femoral offset, LLD and stem alignment, no HO was found. Furthermore, complications were not significant differences between two groups. CONCLUSIONS: The no hip extension method during BHH using DAA in geriatric DFNF resulted in faster rehabilitation and same radiographic outcomes with advantages, such as lesser operative time, hospital stay and Hb drop. The no hip extension method also exhibited good safety and effectiveness. Therefore, the no hip extension method may be a favourable option during BHH using DAA for geriatric patients with DFNF.