Direct anterior approach versus posterolateral approach hemiarthroplasty for treating femoral neck fractures in the elderly: a prospective controlled study.

OBJECTIVE

To compare the clinical efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in hemiarthroplasty for treating femoral neck fractures in elderly patients.

METHODS

In a prospective controlled study, elderly patients with femoral neck fractures undergoing hemiarthroplasty at Fujian Provincial National Regional Trauma Center from February 2023 to February 2025 were randomized to the DAA or PLA group. Primary outcomes included Harris Hip Score (preoperatively, and at 1 week, 1 month, and 3 months postoperatively) and Visual Analogue Scale (VAS) pain score. Secondary outcomes included operative time, intraoperative blood loss, transfusion rate, perioperative changes in hemoglobin and creatine kinase, complications, limb length discrepancy, drainage volume, ICU admission rate, hospital stay, and other clinical indicators.

RESULTS

102 patients completed the surgery and 3-month follow-up (DAA: 50; PLA: 52). Baseline characteristics and comorbidities were comparable between groups (P > 0.05). The DAA group had a significantly higher Harris Hip Score at 1 week postoperatively compared to the PLA group (60.97 ± 2.78 vs. 58.92 ± 2.49, P < 0.001), though no significant differences were noted at 1 or 3 months. The overall trend in Harris Hip Score differed significantly between the groups (P = 0.006). VAS pain scores showed no difference at any time point. Limb length discrepancy postoperatively was significantly less in the DAA group [1.725 (0.930, 3.595) mm] than in the PLA group [3.935 (1.940, 5.458) mm, P < 0.001]. No significant differences were observed in operative time, blood loss, transfusion rate, perioperative marker changes, complications, ICU admission, hospital stay, or mortality.

CONCLUSION

DAA in hemiarthroplasty does not increase operative time, blood loss, or complications compared to PLA. DAA provides better early postoperative functional outcomes and less limb length discrepancy in elderly patients with femoral neck fractures.