Bipolar Hip Arthroplasty Using a Conjoined Tendon-preserving Posterior Approach in Geriatric Patients

In bipolar hemiarthroplasty (BHA), it is important to preserve soft tissue to reduce the risk of postoperative dislocation. A variety of surgical approaches for BHA are available, but extra care is needed with muscle- and tendon-preserving approaches in geriatric patients. We investigated the usefulness of BHA using a conjoined tendon-preserving posterior (CPP) approach, in which only the external obturator muscle is dissected, in geriatric patients. We retrospectively analyzed the cases of 40 femoral neck fracture patients (10 men, 30 women) aged >80 years who underwent BHA using the CPP approach. The patients' average age was 85.8 years (80-94 years). We examined the operation time, bleeding, preservation of short external rotator muscles, complications, and stem alignment and subsidence from postoperative radiographs. Although gemellus inferior muscle injury was detected in 4 patients (10%), the hip joint stability was very excellent in all cases. There was no intraoperative fracture or postoperative dislocation. On postoperative radiographs, all femoral stems were in a neutral position. There was no stem subsidence in all 40 patients. BHA using the CPP approach appeared to be useful even in geriatric patients.