Hemiarthroplasty via the direct anterior approach in the lateral decubitus position for elderly patients with unstable intertrochanteric fracture

Purpose The use of hip arthroplasty for the management of intertrochanteric fracture is progressively gaining popularity. This study aimed to assess and compare the clinical and radiological outcomes of hemiarthroplasty for unstable intertrochanteric fractures performed via the direct anterior approach (DAA) and posterior lateral approach (PLA) in elderly patients. Methods This retrospective study included 50 patients with unstable intertrochanteric fractures undergoing hemiarthroplasty between January 2019 and December 2021. Based on the surgical approach, patients were divided into the DAA (n = 25) and PLA (n = 25) groups. Data on the clinical and radiological outcomes, perioperative indicators, and intra- and postoperative complications were collected and statistically analyzed. Results The operative time, blood loss, and blood transfusion volume in the DAA group were significantly lower than those in the PLA group (P < 0.05). Two patients in each group experienced deep vein thrombosis. Two patients experienced dislocation of the hip joint in the PLA group. The visual analog scale (VAS) scores of the DAA and PLA groups were significantly lower than those before operation (P < 0.05). The DAA group had statistically significant differences in VAS scores and 12-item Short form survey (SF-12) mental component summary (MCS) scores compared with the PLA group at 1 month postoperatively (P < 0.05). At the final follow-up, no statistically significant differences were observed in VAS scores, Harris hip scores, and SF-12 scores between the two groups (P > 0.05). Conclusion This study revealed that hemiarthroplasty via DAA in lateral decubitus position is a safe and effective option for elderly patients with unstable intertrochanteric fractures.