Title:
Differences in Surgical Approach to the Hip for the Treatment of Femoral Neck Fractures: Anterior vs. Lateral Approach

Authors: Ilan Y. Mitchnik, MD; Addy S. Brandstetter, MD; Johnathan G. Silberzweig, MSc; On I. Solomon, MD; Ofir Vinograd, MD; Noam Shohat, MD

Background

Osteoporotic femoral neck fractures are frequently managed with hip arthroplasty, a procedure critical for reducing prolonged immobility and its associated complications. Among the various surgical approaches, the Direct Anterior Approach (DAA) is believed to offer superior short-term functional outcomes. This study aimed to investigate whether performing hip arthroplasty for femoral neck fractures using the DAA correlates with improved postoperative ambulation compared to the Direct Lateral Approach (DLA).

Methods

We conducted a retrospective analysis of all subcapital femoral neck fractures managed by hip arthroplasty at our tertiary medical center between 2018 and 2024. Cases involving total hip arthroplasty (THA) were excluded, as all THAs were performed via DAA, while hemi-arthroplasties ("Bipolar") were conducted using either DAA or DLA. Data were extracted from medical records, physiotherapy charts, and surgical reports, focusing on demographic details, surgical approach, implant type, postoperative walking distances, and hospitalization outcomes.

Results

Our medical center performed hip arthroplasties for 938 patients with femoral neck fractures between the years 2018 and 2024, with 66% being female and a median age of 80 years (IQR = 73-86). Hemi-arthroplasty was performed on 810 patients (86%), with the remaining undergoing THA. We excluded 291/810 patients who were not operated on by senior orthopaedic surgery specialists. On the remaining 519 patients with femoral neck fractures who underwent hemi- hip arthroplasties, 439 (85%) underwent DLA, and 80 (15%) underwent DAA.Both groups had comparable age, sex and Charlson Comorbidity Index distributions. The average length of hospital stay was 7.1 days (SD = 6.7) for the DAA group and 6.4 days (SD = 4.7) for the DLA group (p = 0.379). Discharge rates to rehabilitation rather than home were also similar (DAA 61%, DLA 67%, p = 0.842). We measured the walking distances of 21 patients who underwent hemi-arthroplasty via DAA and compared them to 21 matched patients who received the same procedure via DLA. On postoperative day one, patients in the DAA group walked an average of 18.9 meters (SE = 5.4), whereas the DLA group averaged 7.8 meters (SE = 3.5), p = 0.116.

Conclusion

Preliminary findings suggest that patients undergoing hemi-hip arthroplasty for femoral neck fractures with the DAA may experience better early postoperative ambulation and improved short-term functional outcomes, potentially reducing the period of immobilization. However, the current analysis is limited by the small sample size, and we plan further investigation to achieve sufficient statistical power to confirm these findings.