Anterior approach without traction table: A means of saving time and money in hemiarthroplasty for femoral neck fracture? A case-matched study with and without traction table.

Abstract Background The costs incurred by management of displaced femoral neck fracture are a public health issue. The anterior approach can be used for partial hip replacement, but costs in terms of equipment and time incurred by using a traction table have not to our knowledge been estimated in this indication. We therefore performed a case-control study, comparing (1) installation and deinstallation times (IT, DT) in partial hip replacement using a standard versus a traction table (ST, TT), and (2) operating times, limb-length radiography and intraoperative complications. Hypothesis Performing the anterior approach on a standard table saves installation and deinstallation time and operating time, without leading to more intraoperative complications. Materials and methods A comparative retrospective study included 102 patients (mean age, 84.8 ± 8 years; 46 ST, 56 TT). Installation time (IT) was calculated between entry in the operating room and performance of the incision; operating time (OT) between incision and closure; and deinstallation time (DT) between closure and leaving the operating room. Results Mean IT in ST (25.5 ± 6.2 min) was significantly shorter than in TT (33.9 ± 6.2 min) (p = 1.1*10−9), as were DT (13 ± 4.7 versus 17 ± 3.4 min) (p= 4.1*10−6) and OT (73.5 ± 15.9 versus 82.6 ± 21.3 minutes) (p= 0.01). There were 4 intraoperative complications: 1 greater trochanter fracture in ST and 2 greater trochanter fractures and 1 proximal femoral fracture in TT. Limb-length discrepancy was comparable between ST (3.7 ± 3.2 mm (range, 0-15 mm)) and TT (5.3 ± 4.6 mm (range, 0-20 mm)) (p = 0.06). Discussion Patient installation on a standard table reduced installation, deinstallation and operating time compared to use of a traction table, without increasing the complications rate. Level of evidence III, case-control study.