Bipolar hemiarthroplasty of hip joint: prospective randomised comparative study of direct anterior approach versus posterior approach

Background: The dilemma while treating cases with hemiarthroplasty is the surgical approach to be employed. The aim of present study is comparison of posterior approach and direct anterior approach with regards to various relevant outcomes and evaluate early surgical complications.Methods: In this randomized observational study conducted over 2 years, 20 patients each with intra-capsular neck femur fracture were enrolled as per predefined selection criteria and treated with hemiarthroplasty (bipolar) either by posterior approach or by direct anterior approach. Follow up was done for all the patients at regular intervals with standard post-operative protocol, including evaluation for surgical complications, active range of motion and assessment of Harris hip score.Results: Overall infection rate was 5% (two patients in posterior approach, no patient in direct anterior approach, the difference being statistically insignificant). No incidences of dislocation were reported in either group. Two patients of posterior approach had abductor weakness. Periprosthetic fracture and deep vein thrombosis were observed in one case each in posterior approach group. In posterior surgical group, excellent Harris hip score in 25% patients, good in 57.5% patients and fair in 17.5% patients were observed; while in direct anterior surgical group, excellent score was observed in 12.5% patients, good in 55% patients and fair in 32.5% patients.Conclusions: No major clinically or statistically significant differences were observed between for outcomes and complications between the two approaches. Larger randomized trials with bigger samples are recommended