Key result
The direct anterior approach significantly reduced postoperative length of stay (5.0 vs 5.8 days) and improved early functional recovery compared to the posterolateral approach in elderly patients.
Why the study?
Enhanced recovery after surgery protocols are increasingly adopted to optimize functional restoration, but the impact of the direct anterior approach during THA on ERAS efficacy in patients with femoral neck fractures needed quantification.
Does the direct anterior approach improve early recovery outcomes in elderly patients with femoral neck fractures undergoing total hip arthroplasty compared to the posterolateral approach?
Cohort (n=231)
No
Does the direct anterior approach improve early recovery outcomes in elderly patients with femoral neck fractures undergoing total hip arthroplasty compared to the posterolateral approach?
Absolute Event Rate: 5% vs 5.8%
p-value: p=0.001
The direct anterior approach for total hip arthroplasty in elderly patients with femoral neck fractures accelerates early functional recovery and reduces postoperative pain compared to the posterolateral approach, without increasing complications.
May support DAA for shorter stays in elderly THA; hypothesis-generating and requires RCT confirmation.
Objective Enhanced recovery after surgery protocols have been increasingly adopted to optimize postoperative functional restoration. This propensity score-matched cohort study quantified the impact of the direct anterior approach during THA on ERAS efficacy in patients with femoral neck fractures and analyzed outcomes such as functional recovery acceleration and perioperative complications. Methods The consecutive cohort comprised 231 patients who underwent primary arthroplasty for femoral neck fractures and were stratified by surgical approach: direct anterior (DAA, n = 59) versus posterolateral (PLA, n = 172). The clinical outcomes, such as patient statistics, details of perioperative management, length of stay, pain, Harris hip score, and in-hospital complications, were recorded. This retrospective observational study mitigated the risk of confounding bias by applying propensity score matching. Results With PSM, 51 pairs of well-matched patients were generated for comparison between the DAA group and the PLA group. The incision length decreased to 10.7 ± 1.4 cm in the DAA group, whereas it was 13.1 ± 1.3 cm in the PLA group. Compared with the PLA cohort, the DAA cohort had a significantly shorter postoperative length of stay (P = 0.001) but superior limb-length discrepancy control (P < 0.001). Compared with the PLA group, the DAA group demonstrated superior early pain control (VAS score reduction: 3/7/14 days, P < 0.05) and accelerated functional gains (HHS improvement: 7/14 days/1 month, P < 0.05), although the 6-month outcomes were similar between groups (P = 0.675). The DAA group exhibited superior 1-month outcomes in terms of pain control, device independence, and ambulation (P < 0.05), but there were similar complication profiles between the groups. Conclusions Compared with the posterolateral approach, DAA enhances early recovery outcomes in THA among elderly patients with femoral neck fractures undergoing ERAS protocols. DAA demonstrated superior short-term functional gains and similar long-term outcomes compared with the posterolateral approach. These findings support the strategic use of DAA for optimizing early recovery for this patient population.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2025) conducted a cohort in Femoral neck fractures (n=231). Direct anterior approach vs. Posterolateral approach was evaluated on Postoperative length of stay (days) (p=0.001). The direct anterior approach significantly reduced postoperative length of stay (5.0 vs 5.8 days) and improved early functional recovery compared to the posterolateral approach in elderly patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: