2y
Background: The relevance of femoral neck fractures (FNFs) increases with the ageing of numerous societies,
injury-related decline is observed in many patients. Treatment strategies have evolved towards primary joint
replacement, but the impact of different approaches remains a matter of debate. The aim of this trial was to
evaluate the benefit of an anterior minimally-invasive (AMIS) compared to a lateral Hardinge (LAT) approach for
hemiarthroplasty in these oftentimes frail patients.
Methods: Four hundred thirty-nine patients were screened during the 44-months trial, aiming at the evaluation of
150 patients > 60 yrs. of age. Eligible patients were randomised using an online-tool with completely random
assignment. As primary endpoint, early mobility, a predictor for long-term outcomes, was evaluated at 3 weeks via
the “Timed up and go” test (TUG). Secondary endpoints included the Functional Independence Measure (FIM), pain,
complications, one-year mobility and mortality.
Results: A total of 190 patients were randomised; both groups were comparable at baseline, with a predominance
for frailty-associated factors in the AMIS-group. At 3 weeks, 146 patients were assessed for the primary outcome.
There was a reduction in the median duration of TUG performance of 21.5% (CI [− 41.2,4.7], p = 0.104) in the
AMIS-arm (i.e., improved mobility). This reduction was more pronounced in patients with signs of frailty or cognitive
impairment. FIM scores increased on average by 6.7 points (CI [0.5–12.8], p = 0.037), pain measured on a 10-point
visual analogue scale decreased on average by 0.7 points (CI: [− 1.4,0.0], p = 0.064). The requirement for blood
transfusion was lower in the AMIS- group, the rate of complications comparable, with a higher rate of soft tissue
complications in the LAT-group. The mortality was higher in the AMIS-group.
Conclusion: These results, similar to previous reports, support the concept that in elderly patients at risk of frailty,
the AMIS approach for hemiarthroplasty can be beneficial, since early mobilisation and pain reduction potentially
reduce deconditioning, morbidity and loss of independence. The results are, however, influenced by a plethora of
factors. Only improvements in every aspect of the therapeutic chain can lead to optimisation of treatment and
improve outcomes in this growing patient population.
Background: The relevance of femoral neck fractures (FNFs) increases with the ageing of numerous societies,
injury-related decline is observed in many patients. Treatment strategies have evolved towards primary joint
replacement, but the impact of different approaches remains a matter of debate. The aim of this trial was to
evaluate the benefit of an anterior minimally-invasive (AMIS) compared to a lateral Hardinge (LAT) approach for
he...
Fractures ; Personnes âgées ; Gériatrie ; Gérontologie
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