Hip arthroplasty for unstable femoral trochanteric fractures using the direct anterior approach

Abstract Background: This study aims to investigate the clinical outcome of unstable femoral trochanteric fractures treated by hip arthroplasty through direct anterior approach (DAA). Methods: The subjects were patients with unstable femoral trochanteric fractures who were independently ambulatory before injury. Twenty-two patients who underwent hip replacement between 2019 and 2021 (arthroplasty group), and 22 patients treated by osteosynthesis between 2016 and 2018 (osteosynthesis group) were compared. Results: Regarding complications, reoperation, dislocation, or infection did not occur, but over telescoping of the lag screw larger than 10 mm was noted in 4 patients (18.2%) in the osteosynthesis group. No significant difference was noted in the mean Barthel Index score on admission, but it was significantly different at discharge (arthroplasty group: 71.4±17.3, osteosynthesis group: 48.0±23.1, P<0.01). One year after surgery, walking ability before injury was maintained at 71.4% in the arthroplasty group and 36.4% in the osteosynthesis group (P<0.05). Conclusion: Hip arthroplasty through DAA did not cause postoperative dislocation. For unstable trochanteric fractures, patients who underwent hip arthroplasty through DAA had a higher Barthel index at discharge and a higher maintenance rate of walking ability at 1 year after surgery than those who underwent osteosynthesis. Hip arthroplasty through DAA is effective for the treatment of unstable femoral trochanteric fractures considering functional recovery of the hip joint.