Injury - 2026-04-01 - Journal Article; Comparative Study
Comparative outcomes of hip arthroscopy-assisted surgery and the direct anterior approach for Pipkin Type I and II femoral head fractures.
Hsu SL, Hsu CH, Cheng HH, Liao CY
Topics
Key Takeaway
Hip arthroscopy-assisted surgery for Pipkin I/II fractures achieved superior mHHS (97.4 vs. 94.4) and lower blood loss (50 vs. 195 mL) than the direct anterior approach, but at the cost of longer operative time (217 vs. 165 min) and a lower rate of anatomic reduction by Matta criteria.
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Summary
This retrospective study compared hip arthroscopy-assisted surgery versus the direct anterior approach for displaced Pipkin I and II femoral head fractures in 39 patients, also analyzing fragment excision versus internal fixation as a secondary endpoint. Arthroscopy yielded shorter hospital stay (3.4 vs. 8.6 days), less blood loss (50 vs. 195 mL), and higher final mHHS (97.4 vs. 94.4), but longer operative time (217 vs. 165 min) and inferior Matta anatomic reduction rates. Fragment excision produced statistically higher mHHS than internal fixation (98.0 vs. 95.6), though both groups achieved excellent functional scores.
Key Limitation
Non-randomized allocation with no documented selection criteria between groups introduces confounding by indication, as smaller or more favorable fracture patterns may have been preferentially directed to arthroscopy, inflating its apparent functional advantage.
Original Abstract
INTRODUCTION
Comparative evidence regarding the direct anterior approach and hip arthroscopy-assisted surgery for Pipkin type I and II fractures remains limited. This study compares these minimally invasive strategies and evaluates whether fragment excision or internal fixation yields superior functional outcomes.
MATERIALS AND METHODS
Thirty-nine patients with displaced Pipkin type I or II femoral head fractures treated between April 2010 and June 2023 were retrospectively analyzed, with a minimum follow-up of 2 years. Twenty-five underwent hip arthroscopy-assisted surgery and 14 underwent the direct anterior approach. Clinical outcomes were assessed using the modified Harris Hip Score (mHHS). Radiographic evaluation included Matta reduction criteria, osteonecrosis, heterotopic ossification (HO), and hip osteoarthritis (OA). Perioperative variables included operative time, blood loss, postoperative pain (VAS), and length of hospital stay. A secondary analysis compared fragment excision versus internal fixation.
RESULTS
Hip arthroscopy-assisted surgery demonstrated significantly lower perioperative morbidity, with a shorter hospital stay (3.4 ± 1.4 vs. 8.6 ± 4.5 days, P < 0.001) and reduced blood loss (50.0 ± 0.0 vs. 195.0 ± 92.6 ml, P < 0.001) compared with the anterior approach. However, operative time was longer in the arthroscopy group (216.7 ± 48.6 vs. 165.0 ± 37.4 min, P = 0.007). At final follow-up, functional outcomes favored the arthroscopy-assisted group (mHHS: 97.4 ± 1.9 vs. 94.4 ± 4.4, P = 0.010). The anterior approach achieved a significant higher rate of anatomic reduction according to Matta criteria (P = 0.035). Regarding management strategy, fragment excision achieved equivalent excellent mHHS compared with internal fixation (98.0 ± 1.6 vs. 95.6 ± 3.6), though the difference was statistically significant (P = 0.010).
CONCLUSION
Hip arthroscopy-assisted surgery significantly reduced perioperative morbidity and achieved equivalent, excellent clinical function compared with the anterior approach in the short- to mid-term, despite a higher rate of imperfect radiographic reductions. In carefully selected Pipkin type I fractures involving small, non-weight-bearing fragments, fragment excision was associated with favorable functional outcomes, supporting its role as a selective treatment option rather than a universal strategy.
LEVEL OF EVIDENCE
IV: Retrospective cohort study.