Anterior vs Lateral Approach for Hip Fracture Repair

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Hospital Research Institute

Disqualifiers: Under 18

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 7

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines two surgical methods for repairing a broken hip. The Direct Anterior Approach (DAA) involves cutting through muscle, while the other method avoids it. The researchers aim to determine which method improves walking ability, reduces pain, and enhances quality of life after surgery. Individuals needing hip surgery due to a fracture in the upper thigh bone who can read and sign forms may qualify for this trial. As an unphased trial, it provides an opportunity to contribute to valuable research that could enhance surgical outcomes for future patients.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that these surgical approaches are safe for hip fracture repair?

Research has shown that the direct anterior approach (DAA) for hip surgery is generally safe and can lead to a quicker recovery. Studies have found that this method avoids cutting through muscle, resulting in less damage and a faster return to normal activities. Additionally, the DAA is associated with fewer complications shortly after surgery compared to other methods.

In contrast, the lateral approach, while common, involves cutting through muscle, which can cause more muscle damage and a slower recovery. However, both methods are widely used, and surgeons are skilled at managing any risks.

Overall, the DAA offers clear benefits in terms of safety and recovery time. Both methods are considered safe, but the DAA might provide a smoother recovery process. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about exploring different surgical approaches for hip fracture repair, specifically the anterior and lateral approaches, because each has distinct benefits that could improve patient outcomes. The direct anterior approach (DAA) is less invasive, which might lead to faster recovery times and less postoperative pain by preserving key muscles around the hip. On the other hand, the lateral approach is well-established and may offer more stability for the hip joint. By comparing these two methods, researchers hope to determine which approach offers the best balance of recovery speed, pain management, and long-term joint function.

What evidence suggests that this trial's surgical approaches could be effective for hip fracture repair?

This trial will compare the direct anterior approach with the lateral approach for hip fracture repair. Research has shown that the direct anterior approach for hip surgery, such as hemiarthroplasty, often leads to quicker recovery and less muscle damage compared to other methods. Studies have found that this approach results in fewer complications and better early movement and function. Patients typically experience less trauma and improve their mobility faster after surgery. Overall, the direct anterior approach is associated with better recovery and an improved quality of life soon after the procedure. Meanwhile, the lateral approach, also studied in this trial, is a commonly used method and will provide a comparative perspective on outcomes. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

This trial is for patients needing a hemiarthroplasty due to a femoral neck fracture. Participants must be able to read, write, and sign an informed consent form.

Inclusion Criteria

I am having a partial hip replacement due to a hip fracture.

Patients capable of reading, writing and signing an informed consent form

Exclusion Criteria

I am under 18 years old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Surgery

Participants undergo hemiarthroplasty using either the lateral or direct anterior approach

1 day

1 visit (in-person)

Post-operative Monitoring

Participants are monitored for short-term mobility, quality of life, function, pain, and safety parameters

2 weeks

Multiple visits (in-person and phone calls)

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 weeks

Visits at day 6, day 14, and week 6

What Are the Treatments Tested in This Trial?

Interventions

• surgical approach

Trial Overview The study compares two surgical approaches for hip repair after a fracture: the Direct Anterior Approach (front of the hip) versus the Lateral approach (side of the hip), focusing on recovery speed and patient outcomes.

How Is the Trial Designed?

Group I: Lateral approach for hemiarthroplasty Experimental Treatment 1 Intervention

Patients in this arm will receive a hemiarthroplasty using the lateral approach

Group II: Direct anterior approach for hemiarthroplasty Experimental Treatment 1 Intervention

Patients in this arm will receive a hemiarthroplasty using the direct anterior approach (DAA)

surgical approach is already approved in United States, European Union, Japan for the following indications:

Approved in United States as Direct Anterior Approach for:

• Femoral neck fracture repair
• Hip arthroplasty

Approved in European Union as Direct Anterior Approach for:

• Femoral neck fracture repair
• Hip arthroplasty

Approved in Japan as Direct Anterior Approach for:

• Femoral neck fracture repair
• Hip arthroplasty

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

Published Research Related to This Trial

In a study of 270 patients who underwent direct anterior approach (DAA) hip replacements, there was a notable incidence of complications, including a 10% rate of revision surgeries due to issues like dislocations and leg-length discrepancies.

The study also found that 21% of patients reported symptoms of lateral femoral cutaneous nerve injury, suggesting that while DAA may offer early recovery benefits, the potential for complications warrants cautious consideration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior approach to hip replacement and associated complications: an independent review. Vasantharao, P., Fenbury, D., Khan, R., et al.[2023]

The Direct Anterior Approach (DAA) for hip replacement may lead to less soft tissue damage compared to the Lateral Approach (LA), potentially resulting in improved postoperative mobility and fewer complications for elderly patients with displaced femoral neck fractures.

This study will evaluate 138 patients to compare hip function, complications, and recovery outcomes between the two surgical approaches, aiming to identify which method optimizes recovery and quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol. van der Sijp, MPL., Schipper, IB., Keizer, SB., et al.[2018]

The posterior approach (PA) for hemiarthroplasty in proximal femoral fractures is associated with a significantly higher risk of dislocations and reoperations compared to the anterior approach (AA) and lateral approach (LA), suggesting it may not be the best option for this procedure.

No significant differences were found in terms of perioperative fractures, wound infections, or hospital length of stay among the different approaches, indicating that while the PA has higher risks, it does not necessarily lead to worse overall recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgical Approaches and Hemiarthroplasty Outcomes for Femoral Neck Fractures: A Meta-Analysis. van der Sijp, MPL., van Delft, D., Krijnen, P., et al.[2022]

In a study of 59 active elderly patients with displaced femoral neck fractures, those who underwent total hip arthroplasty using the direct anterior approach (DAA) had significantly better outcomes, including a higher Harris hip score at 6 weeks compared to those who had the direct lateral approach (DLA).

Patients in the DAA group also experienced a shorter hospital stay, averaging 4.2 days compared to 6.8 days for the DLA group, suggesting that DAA may lead to faster recovery and potentially lower healthcare costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Direct Anterior vs. Direct Lateral Approach Total Hip Arthroplasty for Displaced Femoral Neck Fracture. Ben Elyahu, R., Ohana, N., Agabaria, E., et al.[2023]

In a study of 34 elderly patients (average age 82.68 years) undergoing bipolar hemiarthroplasty via the direct anterior approach (DAA), the procedure demonstrated a mean operation time of 83.5 minutes and minimal blood loss (263.53 mL), indicating it is a safe surgical option.

The DAA technique resulted in no cases of infection, dislocation, or reoperation, and patients were able to begin weight-bearing walking just 3 days post-surgery, suggesting effective recovery and stability in the treatment of unstable femoral intertrochanteric fractures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases. Park, JH., Chung, YY., Baek, SN., et al.[2022]

The direct anterior approach (DAA) for total hip arthroplasty (THA) resulted in significantly lower pain levels and total blood loss compared to the lateral approach (LA), based on a meta-analysis of 5 randomized controlled trials involving 475 patients.

Patients undergoing DAA also showed improved walking velocity, stride length, and step length, indicating better functional recovery, although there were no significant differences in overall hip function scores or complication rates between the two approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis. Wang, Z., Bao, HW., Hou, JZ.[2020]

The direct anterior approach (DAA) for total hip arthroplasty (THA) shows a low risk incidence (RI) for dislocation (0.6%) and comparable rates of other complications to traditional THA methods, indicating its safety profile is similar overall.

However, the DAA is associated with specific risks, such as intra-operative trochanter and femoral fractures (0.8% and 0.5%, respectively) and transient lateral cutaneous femoral nerve impairment (0.9%), suggesting that the technique may require a learning curve for surgeons.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. De Geest, T., Fennema, P., Lenaerts, G., et al.[2022]

In a study of 180 elderly patients undergoing Bipolar Hip Hemiarthroplasty using a modified Direct Anterior Approach, the rate of major complications was low, with only 10% developing pneumonia and a 1.7% mortality rate during hospitalization.

The modified DAA allowed for rapid mobilization, with 88.3% of patients able to use walkers or crutches, and 83% discharged to their usual social environment, indicating high patient satisfaction and effective rehabilitation outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of femoral neck fracture with a minimal invasive surgical approach for hemiarthroplasty - clinical and radiological results in 180 geriatric patients. Unger, AC., Dirksen, B., Renken, FG., et al.[2022]

The direct anterior approach (DAA) for total hip arthroplasty (THA) in patients with femoral neck fractures is associated with a significantly lower risk of 90-day dislocation, mechanical revision, and mortality compared to the posterior approach (PA), based on a study of 622 THAs.

While the DAA showed higher in-hospital medical complications, it resulted in better long-term outcomes, suggesting that experienced surgeons should consider this approach to reduce postoperative risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Direct Anterior Approach Total Hip Arthroplasty Is Associated With Reduced 1-Year Mortality and Surgical Complications After Femoral Neck Fracture. Cichos, KH., McGwin, G., Boyd, B., et al.[2023]

Citations

1. nature.com nature.com/articles/s41598-024-83371-x

Clinical efficacy of direct anterior approach versus posterior ... The DAA demonstrates a clear advantage over the PLA in the early to mid-term postoperative period of THA, with less trauma and faster recovery.

2. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-025-05941-7

Direct anterior approach enhances early recovery outcomes in ... Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a ...

3. youtube.com youtube.com/watch?v=Ywy8vaNi7Is

Direct Anterior Approach The Data Behind the Rise of the ... The most commonly used surgical approach for routine toll hip was posterior almost 2/3 and the rest of the approaches were a rarity.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10472647/

Clinical outcomes of DAA and related techniques in hip ... The direct anterior approach can be an effective and safe way to perform a THA. It is the goal of this review to highlight evidence of its outcomes and ...

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S097656622500092X

Direct anterior approach for femoral neck fractures Several studies and meta-analyses have demonstrated that the DAA has fewer complications, dislocations, and better early functional outcomes compared to other ...

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0020138323001134

The direct anterior approach is safe and shortens hospital ... Conclusions. The AA can be safely introduced for the treatment of hip fractures. Similar short-term outcomes relative to the LA were identified. The shorter LOS ...

7. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2800844

Evaluation of Comparative Efficacy and Safety of Surgical ... All surgical approaches except the direct lateral approach were associated with greater improvements of hip score when compared with the posterior approach.