Journal of Orthopaedic Trauma · Jul 2, 2026

Functional Outcomes After Bipolar Hip Hemiarthroplasty by Using the Direct Anterior Approach Versus Posterior and Direct Lateral Approaches: A Retrospective Cohort Study

By Tham SYY, Ng JPH, Zhang X et al.

OBJECTIVES: To compare functional recovery and length of hospital stay in patients undergoing bipolar hip hemiarthroplasty (BHH) for displaced femoral neck fractures using the direct anterior approach (DAA) versus the posterior approach (PA) and direct lateral approach (DLA). DESIGN: Retrospective cohort study using a prospectively maintained hip fracture registry. SETTING: Single tertiary care institution in Singapore. PATIENT SELECTION CRITERIA: Patients aged 60 years and older who underwent BHH for displaced femoral neck fractures (OTA/AO 31-B) between 2020 and 2023 were identified from the institutional hip fracture registry. OUTCOME MEASURES AND COMPARISONS: Functional outcomes were assessed using the Modified Barthel Index (MBI; higher scores indicate better independence) and Parker Mobility Score (higher scores indicate better mobility) at discharge, 6 and 12 months. Mobility status, length of stay, postoperative complications, reoperation, and 1-year mortality were evaluated. Outcomes were compared between DAA and PA after propensity score matching, with an exploratory comparison with the DLA. RESULTS: A total of 504 patients were identified; 400 PA, 79 DAA, and 25 DLA. After matching, 67 DAA cases and 134 PA cases were analyzed. Age and sex distribution were similar between DAA and PA groups (80.7 ± 6.3 vs. 81.1 ± 6.5 years, P = 0.655; female: 79.1% vs. 75.4%, P = 0.556). The DAA group demonstrated a smaller decline in MBI from premorbid baseline to discharge as compared with the PA group [DAA: -49.85 ± 17.88 vs. PA: -55.47 ± 18.90, 95% confidence interval (CI): 0.11-11.13, P = 0.045]. No significant differences were observed between the DAA and PA groups in changes from premorbid to 12-month MBI (DAA: -23.97 ± 27.46 vs. PA: -18.52 ± 26.38, 95% CI: -13.67 to 2.78, P = 0.193) or from premorbid to 12-month Parker Mobility Score (DAA: -2.72 ± 2.90 vs. PA: -2.18 ± 2.46, 95% CI: -1.37 to 0.29, P = 0.198). Length of stay (DAA: 9.88 ± 5.08 vs. PA: 10.20 ± 5.20 days; P = 0.684) and 1-year mortality (DAA: 3.0% vs. PA: 8.2%; P = 0.156) were comparable between DAA and PA groups. CONCLUSIONS: DAA for BHH was associated with better early functional recovery at hospital discharge than PA. However, this advantage did not persist at 12 months, with no significant differences in functional outcomes, length of hospital stay, or 1-year mortality between DAA and PA groups. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

doi.org/10.1097/bot.0000000000003245PubMed 42390361Interventions