Clinical efficacy of supine direct-superior approach versus posterolateral approach in hemiarthroplasty for femoral neck fractures in elderly patients

To evaluate the clinical efficacy of hemiarthroplasty performed via the supine direct superior approach (DSA) in elderly patients with femoral neck fractures (FNF) and to compare outcomes with those of the conventional posterolateral approach (PLA). A retrospective analysis was conducted on 75 elderly patients with FNF who underwent hemiarthroplasty at the 908th Hospital of Chinese People’s Liberation Army Joint Logistics Support Force between January 2021 and January 2024. Patients were divided into a supine DSA group ( n = 35) and a PLA group ( n = 40). Perioperative indicators, postoperative functional recovery, pain scores, and complication rates were compared between the two groups. The primary outcome measure was the Harris Hip Score (HHS), evaluated at postoperative day 1, day 3, and at 1, 3, 6, and 12 months postoperatively. Compared with the PLA group, the supine DSA group had a slightly longer operative time (79.0 ± 10.7 vs. 72.5 ± 10.0 min), but significantly less intraoperative blood loss (149.1 ± 37.4 vs. 219.8 ± 37.2 mL), shorter incision length [5.0 (5.0,6.0) vs. 11.0 (10.0,12.0) cm], earlier ambulation time (12.8 ± 2.5 vs. 16.2 ± 2.8 h), lower postoperative drainage volume (70.3 ± 19.3 vs. 105.0 ± 20.0 mL), and shorter length of hospital stay [7.0 (6.0,9.0) vs. 10.0 (8.0,12.0) days] (all P < 0.05). HHS were significantly higher and VAS pain scores significantly lower in the DSA group at postoperative day 1, day 3, and 1 month ( P < 0.05). No significant differences were observed between groups at 3 months or later. The overall complication rate was significantly lower in the DSA group ( P < 0.05), particularly hip dislocation and deep vein thrombosis. Supine DSA demonstrates clinical advantages in the treatment of elderly FNF, including reduced surgical trauma, faster early functional recovery, and lower complication rates, making it a safe and effective alternative to the conventional PLA.