Minimal incision surgery, hip arthroplasty and oldest olds hip fracture. Early results and prospects

Purpose. Hip arthroplasty implantation is the treatment of displaced neck femoral fractures of the elderly. Local and general morbidity, early and secondary morbidity are not negligible but critical with this population and the rehabilitation is heavy. Improving surgical procedure by limiting adverse effects may potentially improve results.Methods. A prospective longitudinal study in 2004 and 2005, 40 patients (8 men and 32 women) with displaced femoral neck fracture. Mean age : 84 [70-98] ±7 years. An historical reference group. Surgical treatment carried out by the same surgeon. Patient with lateral positioning. Incision’s length matched the BMI. Modified transgluteal approach. Femoral implant: Corail® uncemented or Fjord® cemented when primary instability was encountered; Novae® uncemented press fit dual mobility concept socket or Bipolar hip arthroplasty according to the age or to an existing hip arthritis. Redon® vacuum drainage. No changing of treatment’s algorithms (those of the reference group) except the minimally invasive approach.Results. Skin incision’s length: 7 [6-8] ± 0.7 cm. No enlargement due neither to technical impossibility nor to operative complication. Total hip prosthesis: 18 and bipolar prosthesis: 22. Femoral implants uncemented: 37 and cemented: 3. Same procedure’s length. Operative and post-operative blood loss and analgesic use significantly decreased. Implants’ initial position on the post-operative X-ray similar with those of the reference group. Getting up and walking recovery faster. No skin complication, no secondary or no primary infection and no death within 90 days. No dislocations. All patients reviewed (minimum follow-up > 36 months).Conclusion. Minimally invasive approach for implanting hip prosthesis after femoral neck fractures of the elderly is a reliable procedure which as to be confirmed on longer series. This can limit the surgical harm and so the surgical stay length and this potentially may optimize the rehabilitation. This could lead to substantial ethical, social and economic progresses.