Direct anterior approach improves in-hospital mobility following hemiarthroplasty for femoral neck fracture treatment

Arch Orthop Trauma Surg. 2022 Nov;142(11):3183-3192. doi: 10.1007/s00402-021-04087-5. Epub 2021 Aug 4.


Introduction: In elderly patients, an established treatment for femoral neck fractures is hip hemiarthroplasty (HHA) using the anterolateral approach (ALA). Early postoperative mobilization is crucial to reduce perioperative complications. The direct anterior approach (DAA) has been reported to facilitate early recovery of ambulation and is increasingly popular in elective hip surgery but rarely used in femoral neck fractures. The aim was to compare the outcome of the DAA and the ALA in patients treated for femoral neck fracture.

Materials and methods: All HHAs with complete data sets were reviewed from a tertiary public healthcare institution (2013-2020). Propensity score matching was applied to compensate for possible confounders; outcome parameters were perioperative blood loss, postoperative mobility and pain. Secondary outcomes were duration of surgery, length of stay (LOS), complications, reoperation and mortality rates.

Results: There were 237 patients (mean age 85.8 years) available for analysis. The DAA group mobilized earlier during hospitalization (outside patient room: 50.6 vs 38.6%, p = 0.01; walking on crutches/walker: 48.1 vs 36.1%, p < 0.01), had shorter surgeries (DAA vs ALA: 72.5 vs 89.5 min, p < 0.001) and a trend towards fewer complications (32.9% vs 44.9%, p = 0.076). Blood loss (286 vs 287 ml), LOS (10.4 vs 9.5 days), pain (cessation of opioid medication: 2.9 vs 3.3 days post-op), revision (2.5 vs 3.2%) or mortality (30-days: 7.6 vs 5.7%) did not differ between patient groups.

Conclusions: DAA for HHA led to earlier in-hospital mobility, shorter surgeries and a tendency towards fewer complications. No advantage was found regarding perioperative blood loss and pain.

Keywords: Anterolateral approach; Direct anterior approach; Femoral neck fracture; Hip hemiarthroplasty; Outcome; Treatment.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid
  • Antiviral Agents
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Femoral Neck Fractures* / etiology
  • Femoral Neck Fractures* / surgery
  • Hemiarthroplasty* / adverse effects
  • Hospitals
  • Humans
  • Pain / etiology
  • Treatment Outcome


  • Analgesics, Opioid
  • Antiviral Agents