Trial reportEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025
Direct anterior in lateral decubitus position versus anterolateral approach in bipolar hemiarthroplasty after femoral neck fracture: a randomized controlled trial.
Trial report in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeFemoral neck fractures are common injuries in elderly patients, often managed by bipolar hemiarthroplasty, especially in patients with preexisting functional or cognitive impairments. This study aimed to compare postoperative functional outcomes between the direct anterior approach (DAA) in the lateral decubitus position and the anterolateral approach (ALA) for bipolar hemiarthroplasty.
methodsThis single-center, prospective, single-blinded randomized controlled trial enrolled 44 patients aged ≥ 60 years with displaced femoral neck fractures undergoing bipolar hemiarthroplasty. Participants were randomized into two groups: DAA or ALA, both performed in the lateral decubitus position. The primary outcome was postoperative Harris Hip Score (HHS) at 2, 6, and 18 weeks. Secondary outcomes included pain scores at 24 h postoperatively, operative time, intraoperative blood loss, leg length discrepancy (LLD), and length of hospital stay.
resultsThe DAA group demonstrated significantly higher HHS at 2 weeks (74.0 vs. 60.3; P < 0.001), 6 weeks (82.8 vs. 77.6; P = 0.005), and 18 weeks (87.5 vs. 83.4; P = 0.03) compared to the ALA group. Additionally, the DAA group experienced lower 24-hour postoperative pain scores (2.7 vs. 4.3; P < 0.001), shorter operative times (49.0 vs. 70.8 min; P < 0.001), and reduced intraoperative blood loss (110.9 vs. 184.1 mL; P = 0.02). No significant differences were observed in LLD (P = 0.67) or hospital stay duration (P = 0.21).
conclusionPerforming bipolar hemiarthroplasty via the direct anterior approach in the lateral decubitus position results in improved early postoperative functional outcomes, reduced pain, and shorter operative time compared to the anterolateral approach, supporting its use as the preferred surgical technique in elderly patients.
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