No Difference in Revision Rates or Patient Reported Outcome Measures Between Surgical Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture: An Analysis of 5,025 Primary Total Hip Arthroplasties from the New Zealand Joint Registry

Background Total hip arthroplasty (THA) for femoral neck fracture (FNF) can be performed through different surgical approaches. This study compared the revision rates and patient-reported outcome measures (PROM) by surgical approach. Methods Data from the New Zealand Joint Registry (NZJR) were analyzed for patients undergoing primary THA for FNF from January 2000 to December 2021. A total of 5,025 THAs were performed for FNF; the lateral approach was used in 2,499 (49.7%), the posterior in 2,255 (44.9%), and the anterior in 271 (4.3%). The primary outcome measure was the all-cause revision rate. Secondary outcome measures included revision rates for: dislocation, aseptic femoral component loosening, periprosthetic fracture, and infection. Oxford Hip Scores (OHS) were also collected. Age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, femoral head size, dual mobility use, femoral fixation, and surgeon experience were assessed as potential confounding variables. Results There was no difference in the revision rates between lateral and posterior (P = 0.156), lateral and anterior (P = 0.680), or posterior and anterior (P = 0.714) approaches. There was no difference in the reasons for revision between the lateral and posterior approaches or six-month OHS (P = 0.712). There was insufficient data to compare the anterior approach. Conclusions There is no difference in the overall revision rates, reasons for revision, or OHS between the lateral and posterior surgical approaches for THA performed for FNF. Insufficient data on the anterior approach is available for an accurate comparison.