Introduction

This video demonstrates the steps for the direct anterior approach for hip hemiarthroplasty on a standard surgical table. Pearls, pitfalls, and a detailed view of femoral releases are reviewed. The literature on hemiarthroplasty and approaches are reviewed, and our single-series evidence review on hemiarthroplasty approaches is described. The outcomes of patients who underwent hemiarthroplasty via the direct anterior approach, anterolateral approach, or posterior approach are assessed.

Patients and Methods

A total of 248 patients aged 53 to 103 years (mean age, 82.7 years) who underwent hemiarthroplasty of the hip were retrospectively reviewed. The mean follow-up was 15 months.

Results

Patients who underwent hemiarthroplasty of the hip via the anterolateral approach had a higher risk for intraoperative fracture (14.89%), a longer hospital stay (8.8 days compared with 4.3 days for patients who underwent hemiarthroplasty via the direct anterior approach and 5.9 days for patients who underwent hemiarthroplasty via the posterior approach), and a longer surgical time (116 minutes compared with 95 minutes for patients who underwent hemiarthroplasty via the direct anterior approach or the posterior approach). No statistically significant differences in blood loss, the rate of dislocation, hospital readmission, or wound infections were reported between the three approaches.

Conclusion

Surgical approach is best determined by surgeon experience. Larger, prospective and/or multicenter studies are necessary to better elucidate the intrinsic advantages and disadvantages associated with various surgical approaches for hemiarthroplasty in geriatric patients with a hip fracture.