Direct anterior versus posterolateral approach for bipolar hip hemiarthroplasty in femoral neck fractures: a prospective randomised study.

INTRODUCTION: Femoral neck fractures are a major problem in orthopaedic practice, having a huge impact on society, and involving a large number of elderly patients for whom early recovery is paramount. Thus, the aim of this study was to compare 2 surgical approaches, direct anterior (DA group) versus posterolateral (PL group), used for bipolar hip hemiarthroplasty (BHA) with femoral neck fractures in order to assess pain recovery after surgery. Our hypothesis was that early pain recovery would be faster in the DA group. METHODS: 100 patients were randomised to surgery using either a DA group or PL group approach, and were then followed up for 6 months. Surgical time, intra- and postoperative complications were recorded for each patient. The main outcome, pain, was recorded using an NRS scale at 3 days, 1, 3 and 6 months after surgery. At the same time, patient status was evaluated using Activities of Daily Living and Cumulated Ambulation Score scales. RESULTS: Surgical time was longer in the DA group (p < 0.0001). Pain perception at 3 days and at 1 month after surgery was significantly lower in DA group patients (p < 0.0001). The results of the other scales were comparable in the 2 groups (at 3 days, 1 and 3 months after surgery). DISCUSSION: The DA approach offers a significant advantage in terms of pain perception up to 1 month after the operation. Early recovery in terms of pain perception is an important finding. Future studies should explore whether this early pain reduction could translate into a faster rehabilitation programme for an earlier recovery of full function.Clinical trial registration: Protocol 423/CE; Study n. CE 41/15.

Cross-cultural validation of the Italian version of the Cumulated Ambulation Score.

Hip fractures are common in elderly patients, and walking impairment is a frequent complication. The Cumulated Ambulation Score (CAS) is a validated functional scale used to monitor easily three basic mobility activities in patients with hip fracture. The aim of this study was to translate, cross-cultural adapt, and validate the CAS in the Italian language (CAS-I). The translation was carried out according to recommended guidelines. The final version of the CAS-I was administered to 80 geriatric patients with hip fracture admitted to a Traumatology Unit, and allowed full weight-bearing after treatment with hemiarthroplasty. Two raters evaluated each patient 2 days after surgery and then after 3 months. Statistical methods included Cronbach's α coefficient for the scale's internal consistency; the total agreement; and the κ coefficient for the inter-rater reliability. The concurrent validity of the scale was determined by comparing the total CAS-I (0-6 points) with the Index of Independence in Activities of Daily Living score (0-4 points). Internal consistency and inter-rater reliability of the CAS, evaluated with Cronbach's α and κ, respectively, were above 0.84 and 0.94. The SE of measurement for the total CAS-I (0-6 points) 2 days and 3 months after surgery were 0.03 and 0.13 points, respectively. The CAS-I showed a significant correlation with the first four items of the Activities of Daily Living score scale (r≥0.85, P<0.001). This study confirms the validity of the CAS-I for patients with a hemiarthroplasty after hip fracture and provides additional evidence of the psychometric properties of the scale. We suggest that the official CAS-I version be used in other settings to evaluate the basic mobility in patients with hip fracture.