Study Summary

44 patients with displaced femoral neck fractures were randomized to undergo bipolar hemiarthroplasty via the direct anterior approach (DAA) in the lateral decubitus position or the anterolateral approach (ALA). In total, 18 patients in each group were included in the 18-week analysis. The primary outcome of interest was postoperative Harris Hip Score (HHS) at 2, 6, and 18 weeks. Secondary outcomes included 24-hour postoperative visual analogue scale (VAS) pain scores, operative time, intraoperative blood loss, leg length discrepancy (LLD), length of hospital stay, and perioperative complications. Overall, the results of the study revealed that the DAA group achieved significantly higher early HHS scores at all measured time points compared with the ALA group. Additionally, the DAA group experienced lower early postoperative pain, shorter operative times, and reduced blood loss. No significant differences were observed in leg length discrepancy or hospital stay duration. These findings support the DAA in the lateral decubitus position as the best approach for early functional recovery in elderly patients undergoing bipolar hemiarthroplasty.