Journal of Orthopaedics and Traumatology · IF 3.5 · August 13, 2026 · LoE III
One-year mortality of the anterior approach compared with other approaches in elderly patients with hip fracture treated with hemiarthroplasty: a national registry study
Tijs J. M. de Koningh, Thomas Bosch, Rudolf W. Poolman, Maaike G. J. Gademan, Pieter Bas de Witte — Leiden University Medical Center
This Dutch registry study of over 40,000 patients aged 75+ who had hemiarthroplasty for hip fracture compared 1-year mortality by surgical approach (anterior, posterolateral, anterolateral, straight lateral). After propensity score matching about 21,393 patients, mortality was essentially identical across approaches (26% for DAA, PLA, and SLA, 27% for ALA), with no significant differences on Cox regression.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThe direct anterior approach is increasingly popular and marketed for faster recovery, so this large registry study helps temper expectations that it improves survival after hip fracture hemiarthroplasty.
Conclusion strengthConfirms prior evidence
The conclusion asserts a benefit the primary outcome did not show.
Presenting this at rounds? Start here
- ?If DAA does not reduce mortality after hemiarthroplasty, should surgeons choose approach based on other factors like dislocation risk, mobilization speed, or surgeon familiarity instead?
- ?Given the fragility of hip fracture patients, is 1-year mortality even the right outcome to judge approach choice, or should function and complications weigh more heavily in decision-making?