Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2024; 12(6): 1076-1083
Published online Feb 26, 2024. doi: 10.12998/wjcc.v12.i6.1076
Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures
Ting-Xin Yan, Sheng-Jie Dong, Bo Ning, Yu-Chi Zhao
Ting-Xin Yan, Sheng-Jie Dong, Yu-Chi Zhao, Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
Bo Ning, Department of Joint Surgery, Dongying People's Hospital, Dongying 257091, Shandong Province, China
Author contributions: Zhao YC designed the report; Yan TX collected the patients’ clinical data; Dong SJ analyzed the data, Yan TX and Ning B wrote the paper; All authors read and approved the final manuscript.
Institutional review board statement: The Clinical Trial Ethics Committee of Yantaishan Hospital provided approval for this study (IRB No. LL-2023-161-L).
Informed consent statement: During outpatient follow-up, the patients signed an informed consent form to be included in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author at The data are not publicly available due to privacy or ethical restrictions.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yu-Chi Zhao, PhD, Associate Specialist, Doctor, Surgeon, Department of Joint Surgery, Yantaishan Hospital, No. 10087 Science and Technology Avenue, Laishan District, Yantai 264003, Shandong Province, China.
Received: November 20, 2023
Peer-review started: November 20, 2023
First decision: December 15, 2023
Revised: December 30, 2023
Accepted: January 27, 2024
Article in press: January 27, 2024
Published online: February 26, 2024

Hip fractures account for 23.8% of all fractures in patients over the age of 75 years. More than half of these patients are older than 80 years. Bipolar hemiarthroplasty (BHA) was established as an effective management option for these patients. Various approaches can be used for the BHA procedure. However, there is a high risk of postoperative dislocation. The conjoined tendon-preserving posterior (CPP) lateral approach was introduced to reduce postoperative dislocation rates.


To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.


We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA. The patients were followed up for at least 1 year. Among the 80 patients, 57 (71.3%) were female. The time to operation averaged 2.3 d (range: 1-5 d). The mean age was 80.5 years (range: 67-90 years), and the mean body mass index was 24.9 kg/m2 (range: 17-36 kg/m2). According to the Garden classification, 42.5% of patients were type Ⅲ and 57.5% of patients were type Ⅳ. Uncemented bipolar hip prostheses were used for all patients. Torn conjoined tendons, dislocations, and adverse complications during and after surgery were recorded.


The mean postoperative follow-up time was 15.3 months (range: 12-18 months). The average surgery time was 52 min (range: 40-70 min) with an average blood loss of 120 mL (range: 80-320 mL). The transfusion rate was 10% (8 of 80 patients). The gemellus inferior was torn in 4 patients (5%), while it was difficult to identify in 2 patients (2.5%) during surgery. The posterior capsule was punctured by the fractured femoral neck in 3 patients, but the conjoined tendon and the piriformis tendon remained intact. No patients had stem varus greater than 3 degrees or femoral fracture. There were no patients with stem subsidence more than 5 mm at the last follow-up. No postoperative dislocations were observed throughout the follow-up period. No significance was found between preoperative and postoperative mean Health Service System scores (87.30 ± 2.98 vs 86.10 ± 6.10, t = 1.89, P = 0.063).


The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications. For surgeons familiar with the posterior lateral approach, there is no need for additional surgical instruments, and it does not increase surgical difficulty.

Keywords: Conjoined tendon preserving, Bipolar hip arthroplasty, Femoral neck fractures, Postoperative dislocation, Posterolateral approach

Core Tip: We evaluated the effectiveness and safety of the conjoined tendon-preserving posterior (CPP) approach for bipolar hemiarthroplasty (BHA) during a short-term follow-up. We retrospectively evaluated 80 patients who underwent CPP BHA implanted with cementless femoral protheses. We protected the posterior structures of the hip joint. We made a partial incision in the quadratus femoris muscle to increase exposure, thus making the surgical procedure more feasible. There was no dislocation or other adverse events observed during the early follow-up period. The CPP approach can effectively reduce dislocation after BHA and improve postoperative hip joint stability.