Anterior total hip arthroplasty outcomes in the treatment of femoral neck fractures: a retrospective cohort study

Background: A prior study reported a 22% complication rate using the direct anterior (DA) approach for total hip arthroplasty (THA) in the displaced femoral neck fracture population. This seemed contrary to institutional experience; this study investigated outcomes and complication rates for DA THA used in the displaced femoral neck fracture population. Methods: This retrospective cohort study identified and analyzed patients undergoing DA THA for a femoral neck fracture over a 4-year period at a level 1 academic trauma center who were treated by an experienced senior surgeon. Results: Thirty-seven patients (21 women, 16 men) were included in the final analysis. The mean age was 70.9 (SD 11.30) years. All patients received cementless components. One (2.7%) intraoperative greater trochanteric fracture and one (2.7%) in-hospital mortality were recorded. Average follow-up was 10.46 mo (range 0 to 53 mo). There were no reported postoperative periprosthetic fractures, dislocations, or revision arthroplasties. No deep venous thromboses or pulmonary embolisms occurred within 90 days of surgery. There were two (5%) deep infections. The overall complication rate was 8.1%. Patient-reported outcomes were available for 32 patients. Visual Analog Scale pain was 2.59 at 6 wk average compared with 1.83 at 12 mo. Hip Disability and Osteoarthritis Outcome Score Quality of Life at 6 wk averaged 46.69 compared with 59.24 at 12 mo. Conclusions: The direct anterior approach for THA can be a safe option for experienced surgeons. Level of Evidence: Level III.