Wang Yansong, Hou Jianwei, Feng Jun, Li Hongbin, Wang Xiaodong
Department of Orthopedics, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226006, Jiangsu Province, China.
J Orthop Surg Res. 2025 May 24;20(1):512. doi: 10.1186/s13018-025-05941-7.
Objective Enhanced recovery after surgery protocols have been increasingly adopted to optimize postoperative functional restoration. This propensity score-matched cohort study quantified the impact of the direct anterior approach during THA on ERAS efficacy in patients with femoral neck fractures and analyzed outcomes such as functional recovery acceleration and perioperative complications. Methods The consecutive cohort comprised 231 patients who underwent primary arthroplasty for femoral neck fractures and were stratified by surgical approach: direct anterior (DAA, n = 59) versus posterolateral (PLA, n = 172). The clinical outcomes, such as patient statistics, details of perioperative management, length of stay, pain, Harris hip score, and in-hospital complications, were recorded. This retrospective observational study mitigated the risk of confounding bias by applying propensity score matching. Results With PSM, 51 pairs of well-matched patients were generated for comparison between the DAA group and the PLA group. The incision length decreased to 10.7 ± 1.4 cm in the DAA group, whereas it was 13.1 ± 1.3 cm in the PLA group. Compared with the PLA cohort, the DAA cohort had a significantly shorter postoperative length of stay (P = 0.001) but superior limb-length discrepancy control (P < 0.001). Compared with the PLA group, the DAA group demonstrated superior early pain control (VAS score reduction: 3/7/14 days, P < 0.05) and accelerated functional gains (HHS improvement: 7/14 days/1 month, P < 0.05), although the 6-month outcomes were similar between groups (P = 0.675). The DAA group exhibited superior 1-month outcomes in terms of pain control, device independence, and ambulation (P < 0.05), but there were similar complication profiles between the groups. Conclusions Compared with the posterolateral approach, DAA enhances early recovery outcomes in THA among elderly patients with femoral neck fractures undergoing ERAS protocols. DAA demonstrated superior short-term functional gains and similar long-term outcomes compared with the posterolateral approach. These findings support the strategic use of DAA for optimizing early recovery for this patient population.
目的 越来越多地采用术后加速康复方案来优化术后功能恢复。这项倾向评分匹配队列研究量化了全髋关节置换术中直接前路手术对股骨颈骨折患者加速康复外科疗效的影响，并分析了功能恢复加速和围手术期并发症等结果。方法 连续队列包括231例行股骨颈骨折初次关节置换术的患者，根据手术入路分层：直接前路（DAA，n = 59）与后外侧入路（PLA，n = 172）。记录临床结果，如患者统计数据、围手术期管理细节、住院时间、疼痛、Harris髋关节评分和院内并发症。这项回顾性观察性研究通过应用倾向评分匹配降低了混杂偏倚的风险。结果 通过倾向评分匹配，生成了51对匹配良好的患者用于DAA组和PLA组之间的比较。DAA组切口长度降至10.7±1.4 cm，而PLA组为13.1±1.3 cm。与PLA队列相比，DAA队列术后住院时间显著缩短（P = 0.001），但肢体长度差异控制更佳（P < 0.001）。与PLA组相比，DAA组早期疼痛控制更佳（视觉模拟评分法[VAS]评分降低：3/7/14天，P < 0.05）且功能恢复加速（Harris髋关节评分改善：7/14天/1个月，P < 0.05），尽管两组6个月时的结果相似（P = 0.675）。DAA组在疼痛控制、器械独立和行走方面1个月时的结果更佳（P < 0.05），但两组并发症情况相似。结论 与后外侧入路相比，直接前路手术可增强接受加速康复外科方案的老年股骨颈骨折患者全髋关节置换术后的早期恢复结果。与后外侧入路相比，直接前路手术显示出更好的短期功能恢复且长期结果相似。这些发现支持将直接前路手术策略性地用于优化该患者群体的早期恢复。
