Early clinical efficacy of hip hemiarthroplasty via the SuperCap approach vs. the posterolateral approach in elderly patients with femoral neck fractures: a randomized controlled trial.

OBJECTIVE

To evaluate the clinical efficacy, perioperative trauma, and early functional recovery trajectory of hip hemiarthroplasty (HA) via the SuperCap approach vs. the traditional posterolateral approach (PLA) in patients aged ≥75 years with displaced femoral neck fractures (FNFs).

METHODS

A prospective, single-center, randomized controlled trial was conducted between July 2023 and January 2024, initially recruiting 52 geriatric patients with displaced FNFs (Garden types III and IV). Forty-eight patients (24 per group) completed the 6- and 12-month functional assessments. The primary outcome was the Harris Hip Score (HHS) at 6 months postoperatively. Secondary outcomes encompassed perioperative metrics, early mobility indices [Time to Mobilization, Timed Up and Go (TUG)], pain Visual Analog Scale (VAS), laboratory biomarkers of muscle trauma and inflammation [e.g., creatine kinase (CK), hemoglobin (Hb)], radiographic positioning, and complications.

RESULTS

The primary outcome (6-month HHS) showed no statistically significant difference between groups (91.04 ± 1.46 vs. 90.67 ± 1.97; mean difference 0.37; 95% CI -0.64 to 1.38; P = 0.466). However, the SuperCap cohort yielded significantly superior early functional recovery, evidenced by higher HHS and lower VAS scores up to 3 months postoperatively (P < 0.05). The SuperCap group demonstrated superior perioperative metrics, including shorter operative time (35.79 ± 4.19 vs. 50.71 ± 5.18 min), smaller incisions (6.03 ± 0.54 vs. 9.75 ± 1.07 cm), reduced intraoperative blood loss (87.50 ± 27.70 vs. 139.17 ± 36.23 mL), and shorter hospital stays (all P < 0.05). Postoperative day-1 Hb was significantly higher, and CK levels were significantly lower in the SuperCap group (P < 0.05), consistent with reduced muscle trauma. SuperCap patients also exhibited faster Time to Mobilization and shorter TUG duration. Radiographic component positioning and complication rates were comparable between groups.

CONCLUSION

While achieving comparable short-term functional outcomes to the traditional PLA, the SuperCap approach significantly minimizes skeletal muscle trauma, reduces perioperative blood loss, and accelerates early functional rehabilitation. It serves as a highly effective, tissue-sparing option that facilitates rapid postoperative recovery in vulnerable geriatric patients.

CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300073391.