The John Charnley Award: The Anterior Approach Does Not Improve Recovery after Hemiarthroplasty for Femoral Neck Fracture. A Randomized Controlled Trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(21):5 J Arthroplasty . 2025 Aug;40(8S1):S17-S24.e1.What this means for my practice?
For cognitively intact older adults undergoing hemiarthroplasty for femoral neck fracture, AA does not improve early functional recovery or patient-reported outcomes compared with LA and may compromise cement mantle quality while modestly prolonging operative time. Clinically, surgeons should not expect early-recovery benefits from AA in this setting, and widespread adoption is not supported by this RCT. Limitations include single-center design, per-protocol analysis, inclusion of only cognitively intact patients, surgeons beyond AA learning curves, and absence of objective performance tests—factors that may limit generalizability.
Study Summary
One hundred and sixteen patients with displaced femoral neck fractures were randomized to receive hemiarthroplasty via the anterior approach (AA) (n=58) or the lateral approach (LA) (n=58). The primary outcome was function at 6 weeks on the Barthel-20 Index. Secondary outcomes included EQ-5D, pain (VAS; plus 5-day opioid use), length of stay (acute and to rehab discharge), complications (medical and implant-related), readmissions/ED visits, and mortality. Outcomes were assessed at 2, 6, 12, and 24 weeks. Overall, the results revealed no between-group differences for the primary outcome (both groups mean 15.8 at 6 weeks; P=0.98) or for secondary patient-reported outcomes, resource use, complications, readmissions, or mortality; operative time was modestly longer with AA and cement mantle quality was worse. In short, AA did not confer superior recovery versus LA in this population.
Unlock the Full ACE Report
You have access to 4 more FREE articles this month.
Click below to unlock and view this ACE Reports
Unlock Now
Critical appraisals of the latest, high-impact randomized controlled trials and systematic reviews in orthopaedics
Access to OrthoEvidence podcast content, including collaborations with the Journal of Bone and Joint Surgery, interviews with internationally recognized surgeons, and roundtable discussions on orthopaedic news and topics
Subscription to The Pulse, a twice-weekly evidence-based newsletter designed to help you make better clinical decisions
Exclusive access to original content articles, including in-house systematic reviews, and articles on health research methods and hot orthopaedic topics
Or upgrade today and gain access to all OrthoEvidencecontent for as little as $1.99 per week.
Already have an account? Log in
Are you affiliated with one of our partner associations?
Click here to gain complimentary access as part your association member benefits!
0 of 4 monthly FREE articles unlocked
