To compare the clinical efficacy between hemiarthroplasty via direct anterior approach (DAA) and posterolateral approach (PLA) for femoral neck fracture associated with senile dementia.

A retrospective study was conducted to analyze the data of 57 elderly patients with femoral neck fracture associated with senile dementia from February 2021 to February 2022, and the fractures were classified as Garden type Ⅲ and Ⅳ, aged ≥70 years, met the diagnostic criteria for senile dementia and were divided into two groups according to surgical approach. All patients were treated with hemiarthroplasty. Direct anterior approach (DAA) was performed in 27 patients (DAA group) and posterolateral approach (PLA) was performed in 30 patients (PLA group).The surgical time,intraoperative blood loss, time to get out of bed, length of hospital stay, and the complication rate of the two groups were compared. At the follow-up of 1, 3 and 6 months after operation, the functional recovery scale (FRS), Euro Qol-5 dimesions (EQ-5D), mini-mental stateexamination (MMSE) and confusion assessmentmethods (CAM) of the two groups respectively were recorded to evaluate hip joint function, life quality and mental state of the two groups of patients. The SPSS 19.0 statistical software was used to analyze the data of the two groups by t test or corrected t test and Chi-square test.

All 57 patients were followed up for 8-20 months (average 13.85±1.64 months). Compared with that in PLA group, the surgical time and intraoperative blood loss in DAA group were both increased significantly [(78.32±10.63 min) vs (55.12±11.36 min), (285.67±78.52 ml) vs(175.12±62.35 ml), all P<0.05]. Yet, the time to get out of bed and length of hospital stay were both decreased significantly in DAA group [(21.52±10.67 h) vs (62.89±28.34 h), (7.82±2.51 d) vs (12.78±3.32 d), all P<0.05]. At the follow-up of 1 and 3 months after operation, the FRS score[(56.45±8.90) vs (41.34±5.62), (66.94±5.87) vs (50.67±6.36)] and EQ-5D score[(0.72±0.18) vs (0.43±0.15), (0.74±0.25) vs (0.45±0.16)] in DAA group were both higher than that in PLA group (all P<0.05), while the FRS score and EQ-5D score were both similar between the two groups of patients at the follow-up of 6 months after operation [(72.56±9.82) vs (69.90±8.31), (0.77±0.34) vs (0.71±0.26), all P>0.05]. At the follow-up of 1,3 and 6 months after operation, there was no significant difference, in terms of MMSE and CAM, between the two groups of patients (all P>0.05). In addition, the rate of all complication (16.67%) in PLA group was higher obviously than that (7.40%) in DAA group (P<0.05) .

Hemiarthroplasty via DAA for femoral neck fracture in elderly patients with senile dementia is superior to that via PLA, because of less invasion, faster recovery, earlier time to get out of bed, shorter hospital stay, less complications and better hip function in the early period.