One-year mortality of the anterior approach compared with other approaches in elderly patients with hip fracture treated with hemiarthroplasty: a national registry study
Journal of Orthopaedics and Traumatology · 13 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
The direct anterior approach is increasingly popular and marketed for faster recovery, so this large registry study helps temper expectations that it improves survival after hip fracture hemiarthroplasty.
The evidence
This Dutch registry study of over 40,000 patients aged 75+ who had hemiarthroplasty for hip fracture compared 1-year mortality by surgical approach (anterior, posterolateral, anterolateral, straight lateral). After propensity score matching about 21,393 patients, mortality was essentially identical across approaches (26% for DAA, PLA, and SLA, 27% for ALA), with no significant differences on Cox regression.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Target trial emulationDesign starting point: 47.8
Raised the score
- Target trial protocol specified+4.3
- New-user design+3.4
Lowered the score
- 48% loss to follow-up−8.5
Score capped at 55. The conclusion asserts a benefit the primary outcome did not show.
Methods at a glance
Recorded assessment- Confounding adjustmentPropensity scores
- Covariate balance confirmedNot reported
- Outcome assessors blindedNot applicable
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 47.8
- Target trial protocol specified
- +4.3
- New-user design
- +3.4
- Aligned time zero
- +2.5
- Compared against current standard of care
- +3.4
- 12-month follow-up
- +3.4
- 48% loss to follow-up
- −8.5
- Journal prior (not an observed method)
- +0.6
- Methodological cap
- −1.9
- Final rigour score rounded
- 55 / 100
Study design sets the starting point and a ceiling of 90. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If DAA does not reduce mortality after hemiarthroplasty, should surgeons choose approach based on other factors like dislocation risk, mobilisation speed, or surgeon familiarity instead?
2.Given the fragility of hip fracture patients, is 1-year mortality even the right outcome to judge approach choice, or should function and complications weigh more heavily in decision-making?
Original publication title
One-year mortality of the anterior approach compared with other approaches in elderly patients with hip fracture treated with hemiarthroplasty: a national registry study