Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study
Abstract 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 fra...
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BMC
2025-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05941-7 |
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| author | Yansong Wang Jianwei Hou Jun Feng Hongbin Li Xiaodong Wang |
| author_facet | Yansong Wang Jianwei Hou Jun Feng Hongbin Li Xiaodong Wang |
| author_sort | Yansong Wang |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-552dc5b7bbcf44b6b46e01ceaf40a4f9 |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-552dc5b7bbcf44b6b46e01ceaf40a4f92025-08-20T03:48:19ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-05-012011910.1186/s13018-025-05941-7Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort studyYansong Wang0Jianwei Hou1Jun Feng2Hongbin Li3Xiaodong Wang4Department of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong UniversityDepartment of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong UniversityDepartment of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong UniversityDepartment of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong UniversityDepartment of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong UniversityAbstract 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.https://doi.org/10.1186/s13018-025-05941-7Enhanced recovery after surgeryPropensity score matchingTotal hip arthroplastyFemoral neck fracturesDirect anterior approach |
| spellingShingle | Yansong Wang Jianwei Hou Jun Feng Hongbin Li Xiaodong Wang Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study Journal of Orthopaedic Surgery and Research Enhanced recovery after surgery Propensity score matching Total hip arthroplasty Femoral neck fractures Direct anterior approach |
| title | Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study |
| title_full | Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study |
| title_fullStr | Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study |
| title_full_unstemmed | Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study |
| title_short | Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study |
| title_sort | direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures a propensity matched cohort study |
| topic | Enhanced recovery after surgery Propensity score matching Total hip arthroplasty Femoral neck fractures Direct anterior approach |
| url | https://doi.org/10.1186/s13018-025-05941-7 |
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