Clinical efficacy of direct anterior approach versus posterior lateral approach for total hip replacement in middle-aged and elderly patients of femoral neck fracture.

To compare the early to mid-term clinical efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in total hip arthroplasty (THA) for middle-aged and elderly patients with femoral neck fractures. The patients in our hospital from January 2021 to January 2023 were retrospectively selected. Patients were divided into the DAA group (n = 64 cases) and PLA group (n = 69 cases) based on a non-randomized concurrent controlled trial method. Baseline clinical characteristics and preoperative and postoperative data of patients were collected. These patients were followed up one year. There were no significant differences in baseline characteristics between the two groups (P > 0.05). Compared to the PLA group, the DAA group had shorter surgery times (66.33 ± 6.27 vs. 83.32 ± 7.17), shorter incision lengths (9.94 ± 1.10 vs. 13.00 ± 1.48), less intraoperative bleeding (177.81 ± 62.55 vs. 306.34 ± 50.49), and shorter times to postoperative ambulation (1.72 ± 0.83 vs. 3.48 ± 0.63), with all differences being statistically significant (P < 0.05). Moreover, there was no difference in Harris scores between the two groups preoperatively and at 12 months postoperatively (P > 0.05). However, the DAA group was significantly higher than the PLA group at 1 month, 3 months, and 6 months postoperatively (P < 0.05). There was no difference in preoperative VAS scores between two groups (P > 0.05), but the VAS scores were significantly reduced at 1 day, 3 days, 1 week, and 1 month postoperatively in the DAA group (P < 0.05). Imaging parameters after THA (abduction angle, forward angle, and difference in length of the lower limbs) and postoperative complications showed no statistically differences between the two groups (P > 0.05). The DAA demonstrates a clear advantage over the PLA in the early to mid-term postoperative period of THA, with less trauma and faster recovery. Given these benefits, the DAA technique is recommended for widespread adoption in clinical practice.