John Magne Hoseth

Background and purpose: The optimal approach to the hip joint in patients with displaced femoral neck fractures (dFNF) receiving a total hip arthroplasty (THA) remains controversial. We compared the direct lateral approach (DLA) with the direct anterior approach (DAA) primarily on Timed Up and Go (TUG), and secondarily on the Forgotten Joint Score (FJS), the Oxford Hip Score (OHS), EQ5D-5L, and the EQ5D-VAS.Methods: Between 2018 and 2023, we conducted a randomized controlled trial including elderly patients with dFNFs treated with THA. The primary outcome was the difference in TUG at 6 weeks postoperatively. Key secondary outcomes were TUG at 2, 12, and at 52 weeks postoperatively, and FJS, OHS, EQ5D-5L, and EQ5D-VAS at 2, 6, 12, and at 52 weeks postoperatively.Results: 130 patients with a mean age of 78.6 (standard deviation 1.2) were allocated to DAA (n = 64) or DLA (n = 66). There was no statistically significant difference in TUG times at 6 weeks postoperatively between the DAA and the DLA, 16.0 s (95% confidence interval [CI] 13.2–18.7) vs 17.8 s (CI 15.1–20.4), estimated mean difference –1.8 s (CI –5.7 to 2.0). However, patients who underwent DAA had a significantly higher FJS at 2, 6, and 12 weeks.Conclusion: Among elderly patients with dFNF we found no difference between DAA or DLA regarding crude mobility as demonstrated with the TUG test, but patients treated with DAA showed better outcomes in the FJS in the early post-fracture period though not at 52 weeks.

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.

Background: Surgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications. Methods: We collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location. Results: 90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities. Discussion: The fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims. Conclusions: Our findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.