2026 SICOT Annual Meeting: Comparative effectiveness of surgical approaches for hip hemiarthroplasty: A network meta-analysis of 20 randomized trials

20 randomized controlled trials (RCTs) involving 3968 patients were included in this systematic review and network meta-analysis comparing 8 surgical approaches for hip hemiarthroplasty after femoral neck fracture: direct anterior approach (DAA), posterolateral approach (PLA), lateral approach (LA), posterior approach (POST), anterolateral approach (ALA), modified Hardinge (MH), SuperPath (SP), and SPAIRE. Pooled outcomes included operative time, Harris Hip Score (HHS), dislocation, blood loss, hospital stay, and pain. PLA and POST were associated with substantially higher dislocation rates than DAA, while DAA demonstrated better functional outcomes than ALA and was associated with lower pain and shorter hospital stay. Overall, DAA ranked highest across the evaluated approaches, suggesting that it may provide the most favorable balance of stability, function, pain, and recovery.