Orthopadie (Heidelb). 2026 May 7. doi: 10.1007/s00132-026-04841-w. Online ahead of print.
ABSTRACT
BACKGROUND: Different minimally invasive approaches have been established in the management of elective hip arthroplasty. However, there is almost no data on the endoprosthetic treatment of femoral neck fractures in obese patients.
MATERIALS AND METHODS: The monocentric case-control study is based on the retrospective evaluation of a database. Included were patients with a body mass index (BMI) of > 30 kg/m2 who received endoprosthetic treatment due to a femoral neck fracture. The cohort was dichotomized based on the surgical approach: direct lateral (DL) and minimally invasive anterolateral (MIV AL). Demographic and perioperative variables were collected. The primary study objective was the comparison of general and specific complications. The secondary study objective was the comparison of survival rate and mobility according to the Parker score.
RESULTS: A total of 155 surgeries conducted between 2011 and 2024 were included, of which 52 procedures were performed using a DL approach and 103 procedures using an MIV AL approach. The mean age of the overall cohort was 77.9 ± 9.4 years, and the mean BMI was 33.4 ± 3.2 kg/m2. The demographic variables showed a homogeneous distribution. The overall revision rate was noticeably higher for the MIV AL approach, but not statistically significant (p = 0.18). Dislocations (n = 7) and infections (n = 3) occurred exclusively in the MIV AL group. There was no significant difference in mortality or survival rates. The 30-day and 1‑year mortality rates were 0% and 9.0%, respectively (p = 0.776). The mean survival rate according to Kaplan-Meier was 7.1 years (95% confidence interval, 6.12-8.03) without significant differences regarding the surgical approaches (log rank = 0.656). Mobility according to Parker (n = 78) at the time of follow-up was also comparable (p = 0.60).
CONCLUSION: The MIV AL approach to endoprosthetic treatment of femoral neck fractures in obese patients showed a higher, but not significant, dislocation and infection rate compared to the DL approach. For the overall cohort, mortality rates were low. Recording the surgical approaches and BMI in registry data would be useful to generate larger case numbers.
LEVEL OF EVIDENCE: III; retrospective case-control study.
PMID:42096082 | DOI:10.1007/s00132-026-04841-w
