Yuhui Yang,1,2,* Hong Zhang,1,* Qing Dai,1,* Dapeng Zhang,1 Zhaohong Zhou,1 Hai Jiang,2 Yunzhi Peng,2 Jianhua Huang,1 Linyong Hu,1 Qianyue Sun3 

1Second Department of Orthopedics, Ganzhou Hospital of Guangdong Provincial People’s Hospital, Ganzhou, 341000, People’s Republic of China; 2Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China; 3Department of Prosthodontics, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, 510140, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Linyong Hu, Email 15846020@qq.com Qianyue Sun, Email sunqy1989@163.com

Background: Dislocation following hemiarthroplasty (HA) for femoral neck fractures in the elderly was a rare but severe complication. Tissue-sparing SuperPATH approach for HA had been described with promising results in terms of function recovery, transfusion and dislocation rate. The aim of the present study was to investigate the clinical outcomes, perioperative complications, and mortality rate through SuperPATH (SP) and posterolateral (PL) approach in geriatric patients with high dislocation risk.
Methods: A total of 621 patients from January 2015 to January 2024 were retrospectively reviewed. According to high-dislocated risk, 39 patients through SuperPATH approach and 42 patients through posterolateral approach met the inclusion criteria. All the surgeries were performed by the same hip surgery team. The operation time, surgery incision, intraoperative blood loss and complications were evaluated. The postoperative outcomes, especially dislocation and mortality were assessed at 1-month, 6-month, and 1-year follow-up intervals postoperatively.
Results: Compared with PL group, the surgery incision and blood transfusion rate in SP group was significantly decreased. The early Harris hip score in SP group was significantly higher than that of PL group (t = 7.587, p < 0.001) at 1-week postoperatively, without statistic difference at one month and one year. Totally, the one-year mortality for all patients with high risk of dislocation was 18/81 (22.22%). 8 patients sustained one or more dislocations in PL group, while no patients in the SP group did (OR = 1.235, p = 0.004). The incidence of reoperation was significantly lower in SP group. While there was no significant difference of complication and one-year mortality between groups.
Conclusion: SuperPATH approach for bipolar HA was associated with reducing dislocation and accelerating early hip function recovery in high-risk dislocation population. Once predictors of dislocation risk following HA in the elderly were detected, tissue-sparing invasive approach or constrained THA prosthesis might be considered to avoid evitable complications.

Keywords: geriatric patients, femoral neck fracture, hemiarthroplasty, SuperPATH approach, high dislocation risk