Transtrochanteric vs. posterolateral approaches in hemiarthroplasty after proximal femoral nail complications: A comparative study.

Abstract

Background: Proximal femoral nailing is a widely used technique for treating intertrochanteric femur fractures but may result in complications requiring revision surgery. Hemiarthroplasty is a common solution, with the transtrochanteric and posterolateral approaches being two surgical options. This study aimed to compare these approaches in terms of surgical outcomes and complication rates.

Methods: A retrospective analysis was conducted on 79 patients who underwent revision hemiarthroplasty for complications related to proximal femoral nailing between 2019 and 2022. Patients were divided into two groups based on the surgical approach: transtrochanteric (Group 1, n=36) and posterolateral (Group 2, n=43). Key variables included surgical time, intraoperative blood loss, transfusion requirements, functional outcomes (Harris Hip Score), and complication rates. Statistical significance was set at p<0.05.

Results: Group 1 had a shorter surgical time (49.6±5.69 vs. 64.8±10.29 minutes; p<0.001) and lower intraoperative blood loss (395.8±142.89 vs. 474.2±130.94 mL; p=0.004) compared to Group 2. Transfusion requirements were also lower in Group 1 (0.4±0.71 vs. 1.2±1.014 units; p=0.002). Harris Hip Scores were similar between groups (74.7±7.17 vs. 72.4±7.8; p=0.276). Although overall complication rates did not differ significantly (p=0.744), dislocations occurred only in Group 2 (6.5%, n=2).

Conclusion: The findings suggest that the transtrochanteric approach may offer advantages in surgical efficiency and reduced intraoperative challenges. However, both techniques yielded similar functional outcomes and overall complication rates. Further studies are necessary to validate these findings and assess their applicability in varied clinical contexts.