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Open Access Research article

Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

Felix Renken1, Svenja Renken2, Andreas Paech1, Michael Wenzl3, Andreas Unger1 and Arndt P Schulz14*

Author Affiliations

1 University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, D 23538, Lübeck, Germany

2 University Lübeck, Medical Faculty, Lübeck, Germany

3 Klinikum Ingolstadt, Ingolstadt, Germany

4 BG Trauma Hospital Hamburg, Bergedorfer Strasse, Hamburg, Germany

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BMC Musculoskeletal Disorders 2012, 13:141  doi:10.1186/1471-2474-13-141

Published: 8 August 2012



A minimal invasive approach for elective hip surgery has been implemented in our institution in the past. It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery. Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma.


Sixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, the so called “direct anterior approach” (DAA) was chosen, in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty.

Primary outcome parameter was the mobility as measured by the four-item-Barthel index. Secondary outcome parameters included pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. Radiographs were evaluated.


A statistically significant difference (p = 0,009) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS) showed a statistically significant difference (p = 0,035) at day 16. No difference was evident in the comparison of radiographic results.


Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. There is no radiographic evidence that a minimal invasive technique leads to inferior implant position.

Level of Evidence: Level II therapeutic study.