A minimally invasive transpiriformis approach versus the conventional posterolateral approach in total hip arthroplasty for elderly femoral neck fractures: perioperative blood loss and early functional recovery

Li Li, Shaowei Sun, Bobin Fu, Zhixiang Gao, Lijuan Liu, Lifu Wang, Cong Xiao

Background Perioperative blood loss and early recovery are major concerns when elderly patients undergo total hip arthroplasty (THA) for femoral neck fractures. The minimally invasive transpiriformis approach (MIS-TPA), which preserves posterior soft-tissue structures, has recently emerged as an alternative posterior technique. However, its potential benefits over the conventional posterolateral approach (PLA) in reducing blood loss and improving short-term function remain unclear. Methods We retrospectively reviewed elderly patients who underwent primary THA for femoral neck fractures at our institution between October 2023 and September 2024. Patients were classified into the MIS-TPA and PLA groups based on the surgical approach. Perioperative blood loss (total, visible, and hidden) was compared between the two groups. Early functional recovery was assessed using the Harris Hip Score (HHS), and prosthetic positioning was evaluated radiographically. Complications during hospitalization and follow-up were recorded. Results A total of 138 patients were included in this study (PLA, n = 72; MIS-TPA, n = 66). Total perioperative blood loss was significantly lower in the MIS-TPA group than in the PLA group (484.60 ± 46.55 mL vs. 953.30 ± 120.68 mL, P < 0.001), with a corresponding reduction in hidden blood loss (438.96 ± 46.80 mL vs. 659.85 ± 124.47 mL, P < 0.001). Patients in the MIS-TPA group achieved a higher HHS at 1 month postoperatively (79.9 ± 4.7 vs. 73.4 ± 6.0, P < 0.001). No significant between-group differences in the HHS were observed at 3, 6, or 12 months. No statistically significant between-group differences were observed in perioperative complications, transfusion requirements, or prosthetic positioning; however, this study was not powered to draw definitive conclusions regarding rare complications. Conclusions In this cohort of elderly patients undergoing THA for femoral neck fractures, the MIS-TPA was associated with less perioperative blood loss and a more favorable early recovery profile than the PLA. However, this study was not statistically powered to determine differences in rare postoperative complications.