Open AccessHigh risk of positive Trendelenburg test after using the direct lateral approach to the hip compared with the anterolateral approach
Author(s) -
Terje Ugland,
Glenn Haugeberg,
Svein Svenningsen,
Stein Ugland,
Øystein Hjalmar Berg,
Are Hugo Pripp,
Lars Nordsletten
Publication year - 2019
Publication title -
the bone and joint journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.587
H-Index - 181
eISSN - 2049-4408
pISSN - 2049-4394
DOI - 10.1302/0301-620x.101b7.bjj-2019-0035.r1
Subject(s) - medicine , trendelenburg , harris hip score , surgery , femoral neck , outcome (game theory) , osteoarthritis , arthroplasty , osteoporosis , alternative medicine , pathology , mathematical economics , mathematics
Aims The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a femoral neck fracture treated with a hemiarthroplasty.Patients and Methods A total of 150 patients who were treated between February 2014 and July 2017 were included. Patients were allocated to undergo hemiarthroplasty using either an anterolateral or a direct lateral approach, and were followed for 12 months. The mean age of the patients was 81 years (69 to 90), and 109 were women (73%). Functional outcome measures, assessed by a physiotherapist blinded to allocation, and patient-reported outcome measures (PROMs) were collected postoperatively at three and 12 months.Results A total of 11 patients in the direct lateral group had a positive Trendelenburg test at one year compared with one patient in the anterolateral group (11/55 (20%) vs 1/55 (1.8%), relative risk (RR) 11.1; p = 0.004). Patients with a positive Trendelenburg test reported significantly worse Hip Disability Osteoarthritis Outcome Scores (HOOS) compared with patients with a negative Trendelenburg test. Further outcome measures showed few statistically significant differences between the groups.Conclusion The direct lateral approach in patients with a femoral neck fracture appears to be associated with more positive Trendelenburg tests than the anterolateral approach, indicating a poor clinical outcome. Cite this article: Bone Joint J 2019;101-B:793–799.