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

Q: Which outcomes were assessed as primary endpoints?

Primary outcomes included the Harris Hip Score at preoperative, 1 week, 1 month, and 3 months postoperatively, and the Visual Analogue Scale (VAS) pain score.

Q: Did DAA lead to higher operative time, blood loss, or more complications than PLA?

No. The conclusion states that DAA does not increase operative time, blood loss, or complications compared with PLA.

Sep 30, 2026

Uploaded by jay

Objective: Compare the clinical efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in hemiarthroplasty for femoral neck fractures in elderly patients. Methods: In a prospective controlled randomized study (Feb 2023-Feb 2025), outcomes included Harris Hip Score and Visual Analogue Scale (VAS) pain, with secondary measures covering operative metrics, blood loss, biomarkers, complications, limb length discrepancy, ICU admission, and hospital stay. Results: DAA improved early Harris Hip Score at 1 week and reduced postoperative limb length discrepancy; other outcomes showed no significant differences. Conclusion: DAA offers better early functional recovery without increasing operative time, blood loss, or complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

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Abstract

Introduction

Chen et al. Journal of Orthopaedic Surgery and Research (2026) 21:11 [https://doi.org/10.1186/s13018-025-06552-y](https://doi.org/10.1186/s13018-025-06552-y) Journal of Orthopaedic Surgery and Research RESEARCH Open Access Direct anterior approach versus posterolateral approach hemiarthroplasty for treating femoral neck fractures in the elderly: a prospective controlled study Jian Chen 1, Xiaohua Zhang 1 and Wei Xu2,3,4,5,6,7* Abstract 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 hemiarthroplastyat 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. Keywords Femoral neck fracture, Direct anterior approach, Posterolateral approach, Hemiarthroplasty, Elderly *Correspondence: Wei Xu [xworthopedist@163.com](xworthopedist@163.com) 1Department of Emergency Medicine, Fuqing City Hospital of Fujian, Fuzhou, Fujian, China 2Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China 3Department of Emergency and Trauma Surgery, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China 4Fujian Provincial National Regional Trauma Medical Center, Fuzhou, China 5Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, China 6Fujian Provincial Institute of Emergency Medicine, Fuzhou, China 7Fujian Provincial Emergency Medical Center, Fuzhou, China © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the arti

FAQs

What was the study’s main objective when comparing DAA and PLA?

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

Which outcomes were assessed as primary endpoints?

Primary outcomes included the Harris Hip Score at preoperative, 1 week, 1 month, and 3 months postoperatively, and the Visual Analogue Scale (VAS) pain score.

Did DAA lead to higher operative time, blood loss, or more complications than PLA?

No. The conclusion states that DAA does not increase operative time, blood loss, or complications compared with PLA.

Sep 30, 2026

Uploaded by jay