Purpose: This study aimed to determine complication-free survival rates by assessing Barthel Index (BI) grades at discharge and to identify prognostic factors following hip hemiarthroplasty for femoral neck fractures. Materials and Methods: This retrospective study analyzed 404 patients. We collected data on BI scores following surgery and at discharge, BI improvement rate (BI speed), postoperative complications (dislocations, thrombosis, death, infection, and nerve disorder), and peri-hip fractures (contralateral and periprosthetic fractures). Results: Cluster analysis categorized patients into low (<35, n=92), moderate (40-80, n=199), and high (>85, n=113) BI groups. The moderate BI group showed an intermediate BI speed (1.97±1.31/day, P<0.001) and a peri-hip fracture incidence of 11.1% (P=0.015). Four-year complication-free survival rates were 47.5% in the low, 45.9% in the moderate, and 74.7% in the high BI groups (P<0.001). Multivariate analysis identified BI speed as a significant prognostic factor for complications (hazard ratio 0.746, 95% confidence interval 0.560-0.994, P<0.05). Conclusion BI speed is a significant prognostic indicator for complications following hip hemiarthroplasty. Although it does not predict peri-hip fractures, the high fracture incidence in the moderate BI group suggests the need for targeted preventive interventions in this population.

Purpose: The concept of a superior approach (SA) involves the use of a tissue-sparing posterior approach (PA), with exposure of the piriformis muscle and gluteus medius/minimus muscles. The objective of this study was to clarify the features of hip hemiarthroplasty (HA) using a SA in regard to early recovery and mid-term outcomes, with a comparison of the outcomes of SA-HAs and HAs using a PA (PA-HAs). Materials and Methods: A total of 120 HAs for treatment of primary femoral neck fracture with a healthy opposite hip joint were performed in our hospital from 2013 to 2018. Propensity score matching in regard to age, sex, body mass index, walking ability before injury, place of residence, time to surgery, and American Society of Anesthesiologists-Physical Status was performed for 79 patients with SA-HAs and 41 patients with PA-HAs. The final analysis included 34 patients who underwent SA-HAs and 34 patients who underwent PA-HAs. Results: The duration of surgery was 57.1 minutes and 72.1 minutes (P=0.001) for SA-HAs and PA-HAs, respectively. The scores for walking ability at postoperative one week were 4.9±1.4 and 4.2±1.0 (P=0.021) for SA-HAs and PA-HAs, respectively. The Barthel index (BI) at the start of rehabilitation was 26.2±18.7 and 17.4±16.3 (P=0.042) for SA-HAs and PA-HAs, respectively. The 4-year complication-free survival rates were 74.2% and 56.3% for SA-HAs and PA-HAs, respectively (P=0.310). Conclusion SA-HA can be performed without torsion of the muscles and ligaments around the hip joint. Early recovery of walking ability and BI was a significant feature of SA-HAs.

PURPOSE: The difficulty of femoral preparation with supine-position hip hemi-arthroplasty (HA) often leads to intra-operative fractures (IOFs). We aimed to clarify the incidence and types of IOFs in HA for hip fractures performed in the supine and lateral positions. MATERIALS AND METHODS: We retrospectively investigated cases of HA for acute femoral neck fractures from June 2013 to May 2018. We examined the incidence and types of IOFs according to different approaches. We defined supine-position in HA as the supine and hip-hyperextended (over-range) femoral preparation position, and lateral position as the lateral and hip-flexed femoral preparation position. We used a short tapered wedged stem. RESULTS: Supine-position HA was used in 46 patients (23.7%) and lateral-position HA in 148 patients (76.3%). IOFs in supine-position HA occurred in 8 patients (17.4%) and included five Vancouver AGT and three Vancouver B2 fractures. IOFs in lateral-position HA occurred in 3 patients (2.0%) and included one Vancouver AGT and two Vancouver B fractures. Supine-position HA was a risk factor for IOFs (adjusted odds ratio, 9.71; 95% confidence interval, 2.37–39.8; P < 0.01) CONCLUSION: Supine-position in HA is an IOF risk factor and significantly increases the incidence of great trochanter fractures of Vancouver type A.
Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; Femur ; Hemiarthroplasty ; Hip Fractures ; Hip ; Humans ; Incidence ; Minimally Invasive Surgical Procedures ; Odds Ratio ; Periprosthetic Fractures ; Retrospective Studies ; Risk Factors