Less inflammatory response in the direct anterior than in the direct lateral approach in patients with femoral neck fractures receiving a total hip arthroplasty: exploratory results from a randomized controlled trial
DOI:
https://doi.org/10.2340/17453674.2024.41242Keywords:
Fractures, Hip, OsteoporosisAbstract
Background and purpose: It is still debatable which is the least invasive approach to the hip joint in arthroplasty for a femoral neck fracture (FNF). We compared the traditional direct lateral approach (DLA) with the direct anterior approach (DAA) regarding creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb).
Methods: In a randomized controlled trial, 130 elderly patients with dislocated FNFs treated with total hip arthroplasty (THA) were included. CK, CRP, and Hb were measured preoperatively and on postoperative days 1 to 4 and were compared between the DAA and DLA groups using repeated measures mixed-effect models.
Results: The CK level was significantly higher on the 1st postoperative day in the DLA group, 597 U/L (95% confidence interval [CI] 529–666) vs 461 U/L (CI 389–532), estimated mean difference (MD) 136 U/L (CI 38–235). The CRP levels were significantly higher on postoperative days 3 and 4 in the DLA group, 207 mg/L (CI 189–226) vs 161 mg/L (CI 143–180), estimated MD 46 mg/L (CI 19–72) and 162 mg/L (CI 144–181) vs 121 (CI 102–140), estimated MD 41 mg/L (CI 15–68). Blood loss, expressed as difference in Hb, did not differ between the groups.
Conclusion: In an elderly population with FNFs, we found that the DAA, compared with the DLA, results in less CK and CRP increase, but no change in Hb.
Downloads
References
van der Sijp M P L, van Delft D, Krijnen P, Niggebrugge A H P, Schipper I B. Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis. J Arthroplasty 2018; 33(5): 1617-27.e9. doi: 10.1016/j.arth.2017.12.029.
Svenoy S, Westberg M, Figved W, Valland H, Brun O C, Wangen H, et al. Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: early complications in a prospective cohort of 583 patients. Injury 2017; 48(7): 1565-9. doi: 10.1016/j.injury.2017.03.024.
Sköldenberg O, Ekman A, Salemyr M, Bodén H. Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing from posterolateral to anterolateral approach. Acta Orthop 2010; 81(5): 583-7. doi: 10.3109/17453674.2010.519170.
Berstock J R, Blom A W, Beswick A D. A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty. Ann R Coll Surg Engl 2015; 97(1): 11-16. doi: 10.1308/003588414X13946184904008.
Charles T, Bloemers N, Kapanci B, Jayankura M. Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures. World J Orthop 2024; 15(1): 22-9. doi: 10.5312/wjo.v15.i1.22.
Manzo MA, Hali K, Koucheki R, Wolfstadt J I, Edwards T C, Lex J R. Complications and early recovery following hip hemiarthroplasty through the direct anterior approach: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2023; 33(8): 3267-86. doi: 10.1007/s00590-023-03603-0.
Mjaaland K E, Kivle K, Svenningsen S, Pripp A H, Nordsletten L. Comparison of markers for muscle damage, inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: a prospective, randomized, controlled trial. J Orthop Res 2015; 33(9): 1305-10. doi: 10.1002/jor.22911.
Rykov K, Reininga I H F, Sietsma M S, Knobben B A S, Ten Have B. Posterolateral vs direct anterior approach in total hip arthroplasty (POLADA Trial): a randomized controlled trial to assess differences in serum markers. J Arthroplasty 2017; 32(12): 3652-8.e1. doi: 10.1016/j.arth.2017.07.008.
Restrepo C, Parvizi J, Pour A E, Hozack W J. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 2010; 25(5): 671-9.e1. doi: 10.1016/j.arth.2010.02.002.
Ilchmann T, Gersbach S, Zwicky L, Clauss M. Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study. Orthop Rev (Pavia) 2013; 5(4): e31. doi: 10.4081/or.2013.e31.
Hoseth J M. clinicaltrials.gov 2018 [clinicaltrials.gov]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT03695497?term=direct+anterior+approach&cond=Hip+Fractures&cntry=NO&city=Kristiansund&draw=2&rank=1.
Technology. CRUatNUoSa 2019. Available from: https://www.klinforsk.no/info/WebCRF.
Nairn L, Gyemi L, Gouveia K, Ekhtiari S, Khanna V. The learning curve for the direct anterior total hip arthroplasty: a systematic review. Int Orthop 2021; 45(8): 1971-82. doi: 10.1007/s00264-021-04986-7.
Rebalka I, Hawke T. Potential biomarkers of skeletal muscle damage. Biomark Med 2014; 8(3): 375-8. doi: 10.2217/bmm.13.163.
Pagana K D, Pagana T J, Pagana T N. Mosby’s diagnostic & laboratory test reference. 14th ed. St. Louis, MO: Elsevier; 2019.
Neumaier M, Braun K F, Sandmann G, Siebenlist S. C-reactive protein in orthopaedic surgery. Acta Chir Orthop Traumatol Cech 2015; 82(5): 327-31. PMID: 26516948.
Chen B K, Liu Y C, Chen C C, Chen Y P, Kuo Y J, Huang S W. Correlation between C-reactive protein and postoperative mortality in patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res 2023; 18(1): 182. doi: 10.1186/s13018-023-03516-y.
Iorio R, Viglietta E, Mazza D, Iannotti F, Nicolosi I, Carrozzo A, et al. Do serum markers correlate with invasiveness of the procedure in THA? A prospective randomized study comparing direct anterior and lateral approaches. Orthop Traumatol Surg Res 2021; 107(8): 102937. doi: 10.1016/j.otsr.2021.102937.
De Anta-Díaz B, Serralta-Gomis J, Lizaur-Utrilla A, Benavidez E, López-Prats F A. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int Orthop 2016; 40(10): 2025-30. doi: 10.1007/s00264-015-3108-9.
Ugland T O, Haugeberg G, Svenningsen S, Ugland S H, Berg Ø H, Pripp A H, et al. Biomarkers of muscle damage increased in anterolateral compared to direct lateral approach to the hip in hemiarthroplasty: no correlation with clinical outcome : Short-term analysis of secondary outcomes from a randomized clinical trial in patients with a displaced femoral neck fracture. Osteoporos Int 2018; 29(8): 1853-60. doi: 10.1007/s00198-018-4557-y.
Shen J, Ji W, Shen Y, He S, Lin Y, Ye Z, et al. Comparison of the early clinical efficacy of the SuperPath approach versus the modified Hardinge approach in total hip arthroplasty for femoral neck fractures in elderly patients: a randomized controlled trial. J Orthop Surg Res 2023; 18(1): 215. doi: 10.1186/s13018-023-03713-9.
Peters R M, Ten Have B, Rykov K, Van Steenbergen L, Putter H, Rutgers M, et al. The learning curve of the direct anterior approach is 100 cases: an analysis based on 15,875 total hip arthroplasties in the Dutch Arthroplasty Register. Acta Orthop 2022; 93: 775-82. doi: 10.2340/17453674.2022.4802.
Nayashida N, Chihara S, Tayama E, Akasu K, Kai E, Kawara T, et al. Influence of renal function on serum and urinary heart fatty acid-binding protein levels. J Cardiovasc Surg (Torino) 2001; 42(6): 735-40. PMID: 11698938.
Additional Files
Published
How to Cite
License
Copyright (c) 2024 John Magne Hoseth, Otto Schnell Husby, Øystein Bjerkestrand Lian, Tor Åge Myklebust, Tommy Frøseth Aae
This work is licensed under a Creative Commons Attribution 4.0 International License.
