Hip hemiarthroplasty for femur neck fractures: minimally invasive direct anterior approach versus postero-lateral approach

  • E. PalaEmail author
  • M. Trono
  • A. Bitonti
  • G. Lucidi
Original Article • HIP - FRACTURES



The minimally invasive direct anterior approach (MDAA) has been reported to be useful in total hip arthroplasty. The benefits of this approach may be useful for the treatment of femoral neck fractures. Aim of this study is to compare MDAA and postero-lateral approach (PLA) in patients treated with hip hemiarthroplasty for femoral neck fractures.

Materials and methods

Between 2013 and 2014, 109 patients underwent bipolar hip hemiarthroplasty for femoral neck fracture: 88 female and 21 male with a mean age of 88 years old. PLA was performed in 54 cases and MDAA in 55 cases.


The mean surgery time was significantly lower in MDAA group (P = 0.001). The hemoglobin loss was significantly lower in MDAA group (P = 0.02). The mean postoperative pain was significantly lower in the MDAA group (P = 0.001). The mean hospitalization period was 2 days lower in the MDAA group but with no significant difference between the two groups (P = 0.09). Hip dislocation was higher in PLA cases (7.4 %) than in MDAA cases (1.8 %). Periprosthetic fracture occurred only in one case of PLA. Great trochanter fracture occurred in 1 MDAA cases, while no cases were observed in the PLA group.


Minimally invasive direct anterior approach for hip hemiarthroplasty in elderly people with femoral neck fracture provided significant benefit in the early postoperative period when compared to the postero-lateral approach in terms of surgery time, hemoglobin loss, postoperative pain, time of recovery and dislocation rate.

Level of evidence

Therapeutic study, level IV (case series).


Hip hemiarthroplasty Femur neck fractures Minimally invasive direct anterior approach 


Compliance with ethical standards

Conflict of interest

None of the authors have any financial and personal relationships with other people or organizations that could inappropriately influence their work. All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study. The experiments comply with the current laws of the country in which they were performed.


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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyOspedale InfermiRiminiItaly

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