Operative outcomes, complications, and functional recovery of lateral-position direct anterior approach versus posterolateral approach in hemiarthroplasty: a retrospective cohort study

Hip replacement is a standard treatment for femoral neck fractures, but the optimal surgical approach remains uncertain. This study aimed to compare the clinical outcomes of the lateral-position direct anterior approach (DAA) and the posterolateral approach (PLA) in patients undergoing hemiarthroplasty. This retrospective cohort study analyzed clinical data from 56 patients with femoral neck fractures who underwent hemiarthroplasty between February 2019 and September 2022. Patients were classified into a PLA group (n = 28) and a DAA group (lateral-position DAA, n = 28). Perioperative indices, postoperative pain assessed by the visual analogue scale (VAS), Harris Hip Score, Barthel Index, quality-of-life measures, and early postoperative complications were evaluated. The DAA group had a shorter operation time (100.54 ± 11.64 min vs. 110.48 ± 22.32 min, p = 0.041), smaller incision length (9.31 ± 0.31 cm vs. 12.31 ± 1.21 cm, p < 0.001), less intraoperative blood loss (214.95 ± 32.22 mL vs. 268.49 ± 23.53 mL, p < 0.001), and shorter hospital stay (10.68 ± 3.31 days vs. 17.49 ± 2.21 days, p < 0.001) compared with the PLA group. VAS scores were lower in the DAA group on postoperative days 1, 3, and 7 (all p < 0.001). Harris Hip Scores and Barthel Index scores were higher at discharge and at 1 and 3 months postoperatively (all p < 0.001). The incidence of early postoperative complications was lower in the DAA group than in the PLA group (7.14% vs. 42.86%, p = 0.002), including a reduced rate of hip dislocation (3.57% vs. 25.00%). Lateral-position DAA using conventional instruments was associated with improved perioperative outcomes, faster early functional recovery, and fewer early complications compared with PLA in this retrospective cohort. These findings suggest that lateral-position DAA may be a feasible alternative approach; however, prospective studies are required to confirm these results.