JOT - 2026-07-02 - Journal Article
Functional Outcomes Following Bipolar Hip Hemiarthroplasty via the Direct Anterior Approach Versus Posterior and Direct Lateral Approaches: A Retrospective Cohort Study.
Yen Yu TS, Poh Hwee NJ, Xiaoe Z, Leng TT
Topics
Key Takeaway
DAA hemiarthroplasty produced a smaller decline in Modified Barthel Index at discharge versus posterior approach (−49.85 vs −55.47, p=0.045), but this advantage was lost by 12 months with no difference in MBI, Parker Mobility Score, LOS, or 1-year mortality.
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Summary
This study compared functional outcomes of bipolar hemiarthroplasty via DAA versus PA and DLA for displaced femoral neck fractures (OTA/AO 31-B) in patients ≥60 years using a prospectively maintained registry. After propensity score matching, DAA demonstrated a statistically significant but modest advantage in early functional recovery (MBI decline: −49.85 vs −55.47, p=0.045) that did not persist at 6 or 12 months. LOS (9.88 vs 10.20 days, p=0.684) and 1-year mortality (3.0% vs 8.2%, p=0.156) were comparable between groups.
Key Limitation
Retrospective single-institution design with significant group size imbalance (400 PA vs 79 DAA) introduces selection bias that propensity matching only partially mitigates, and surgeon-level variability in approach experience is uncontrolled.
Original Abstract
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).
METHODS
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 (PMS; higher scores indicate better mobility) at discharge, 6 months 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 to 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 analysed. 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% CI: 0.11 to 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 PMS (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
III.