{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:56:34Z","timestamp":1788454594503,"version":"build-2803163510"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Hip fractures in older adults are serious injuries that result in disability, higher rates of illness and death, and a substantial strain on health care resources. High-quality evidence to improve hip fracture care regarding the surgical approach of hemiarthroplasty is lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare 6-month outcomes of the posterolateral approach (PLA) and direct lateral approach (DLA) for hemiarthroplasty in patients with acute femoral neck fracture.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This multicenter, randomized clinical trial (RCT) comparing DLA and PLA was performed alongside a natural experiment (NE) at 14 centers in the Netherlands. Patients aged 18 years or older with an acute femoral neck fracture were included, with or without dementia. Secondary surgery of the hip, pathological fractures, or patients with multitrauma were excluded. Recruitment took place between February 2018 and January 2022. Treatment allocation was random or pseudorandom based on geographical location and surgeon preference. Statistical analysis was performed from July 2022 to September 2022.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Hemiarthroplasty using PLA or DLA.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The primary outcome was health-related quality of life 6 months after surgery, quantified with the EuroQol Group 5-Dimension questionnaire (EQ-5D-5L). Secondary outcomes included dislocations, fear of falling and falls, activities of daily living, pain, and reoperations. To improve generalizability, a novel technique was used for data fusion of the RCT and NE.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 843 patients (542 [64.3%] female; mean [SD] age, 82.2 [7.5] years) participated, with 555 patients in the RCT (283 patients in the DLA group; 272 patients in the PLA group) and 288 patients in the NE (172 patients in the DLA group; 116 patients in the PLA group). In the RCT, mean EQ-5D-5L utility scores at 6 months were 0.50 (95% CI, 0.45-0.55) after DLA and 0.49 (95% CI, 0.44-0.54) after PLA, with 77% completeness. The between-group difference (\u22120.04 [95% CI, \u22120.11 to 0.04]) was not statistically significant nor clinically meaningful. Most secondary outcomes were comparable between groups, but PLA was associated with more dislocations than DLA (RCT: 15 of 272 patients [5.5%] in PLA vs 1 of 283 patients [0.4%] in DLA; NE: 6 of 113 patients [5.3%]) in PLA vs 2 of 175 patients [1.1%] in DLA). Data fusion resulted in an effect size of 0.00 (95% CI, \u22120.04 to 0.05) for the EQ-5D-5L and an odds ratio of 12.31 (95% CI, 2.77 to 54.70) for experiencing a dislocation after PLA.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This combined RCT and NE found that among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, PLA was not associated with a better quality of life than DLA. Rates of dislocation and reoperation were higher after PLA. Randomized and pseudorandomized data yielded similar outcomes, which suggests a strengthening of these findings.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT04438226<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.50765","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T16:00:42Z","timestamp":1704988842000},"page":"e2350765","source":"Crossref","is-referenced-by-count":12,"title":["Posterolateral or Direct Lateral Surgical Approach for Hemiarthroplasty After a Hip Fracture"],"prefix":"10.1001","volume":"7","author":[{"given":"Maria C. J. M.","family":"Tol","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke W.","family":"Willigenburg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariena J.","family":"Rasker","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna C.","family":"Willems","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taco","family":"Gosens","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, ETZ, Tilburg, the Netherlands"},{"name":"Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Heetveld","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Spaarne Gasthuis, Haarlem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn G. M.","family":"Schotanus","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery & Traumatology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands"},{"name":"School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Eggen","sequence":"additional","affiliation":[{"name":"Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mate","family":"Kormos","sequence":"additional","affiliation":[{"name":"Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie L.","family":"van der Pas","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands"},{"name":"Amsterdam Public Health, Methodology, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aad W.","family":"van der Vaart","sequence":"additional","affiliation":[{"name":"Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Carel","family":"Goslings","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf W.","family":"Poolman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands"},{"name":"Department of Orthopedic Surgery, LUMC, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"APOLLO Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"van Roon","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"van Dijk","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jort","family":"Keizer","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne J.H.","family":"Vochteloo","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Joosse","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert","family":"Boonen","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jetse","family":"Jelsma","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieuwertje","family":"Theeuwen","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris J.W.","family":"Ploegmakers","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Schepers","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelien","family":"van der Meij","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svenhjalmar H.","family":"van Helden","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger","family":"Zuurmond","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart A.","family":"van Dijkman","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Berendes","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans G.E.","family":"Hendriks","sequence":"additional","affiliation":[{"name":"for the APOLLO Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"issue":"11","key":"zoi231483r1","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s00198-004-1627-0","article-title":"An estimate of the worldwide prevalence, mortality and disability associated with hip fracture.","volume":"15","author":"Johnell","year":"2004","journal-title":"Osteoporos Int"},{"issue":"21","key":"zoi231483r2","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1056\/NEJMcp1611090","article-title":"Management of acute hip fracture.","volume":"377","author":"Bhandari","year":"2017","journal-title":"N Engl J Med"},{"issue":"23","key":"zoi231483r3","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.1056\/NEJMoa1906190","article-title":"Total hip arthroplasty or hemiarthroplasty for hip fracture.","volume":"381","author":"Bhandari","year":"2019","journal-title":"N Engl J Med"},{"issue":"6","key":"zoi231483r4","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1056\/NEJMoa2108337","article-title":"Cemented or uncemented hemiarthroplasty for intracapsular hip fracture.","volume":"386","author":"Fernandez","year":"2022","journal-title":"N Engl J Med"},{"issue":"11","key":"zoi231483r5","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1007\/s00402-013-1828-0","article-title":"Surgical approach and prosthesis fixation in hip arthroplasty world wide.","volume":"133","author":"Chechik","year":"2013","journal-title":"Arch Orthop Trauma Surg"},{"key":"zoi231483r6","author":"Dutch Arthroplasty Register (LROI)"},{"issue":"2","key":"zoi231483r7","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1177\/1120700020931766","article-title":"Posterolateral or direct lateral approach for hemiarthroplasty after femoral neck fractures: a systematic review.","volume":"31","author":"Tol","year":"2021","journal-title":"Hip Int"},{"issue":"5","key":"zoi231483r8","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1016\/j.arth.2017.12.029","article-title":"Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis.","volume":"33","author":"van der Sijp","year":"2018","journal-title":"J Arthroplasty"},{"issue":"93","key":"zoi231483r9","doi-asserted-by":"publisher","first-page":"732","DOI":"10.2340\/17453674.2022.4547","article-title":"Posterolateral or direct lateral approach for cemented hemiarthroplasty after femoral neck fracture (APOLLO): protocol for a multicenter randomized controlled trial with economic evaluation and natural experiment alongside.","volume":"93","author":"Tol","year":"2022","journal-title":"Acta Orthop"},{"issue":"1","key":"zoi231483r10","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12955-021-01679-y","article-title":"How are you doing in the eyes of your spouse? level of agreement between the self-completed EQ-5D-5L and two proxy perspectives in an orthopaedic population: a randomized agreement study.","volume":"19","author":"Tol","year":"2021","journal-title":"Health Qual Life Outcomes"},{"issue":"4","key":"zoi231483r11","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jval.2016.01.003","article-title":"Dutch tariff for the five-level version of EQ-5D.","volume":"19","author":"M Versteegh","year":"2016","journal-title":"Value Health"},{"issue":"6","key":"zoi231483r13","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1007\/s11136-004-7713-0","article-title":"Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D.","volume":"14","author":"Walters","year":"2005","journal-title":"Qual Life Res"},{"issue":"7351","key":"zoi231483r16","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1136\/bmj.324.7351.1448","article-title":"Randomised trials in surgery: problems and possible solutions.","volume":"324","author":"McCulloch","year":"2002","journal-title":"BMJ"},{"issue":"12","key":"zoi231483r17","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1016\/j.injury.2012.08.061","article-title":"Bias towards dementia: are hip fracture trials excluding too many patients? a systematic review.","volume":"43","author":"Hebert-Davies","year":"2012","journal-title":"Injury"},{"issue":"1","key":"zoi231483r18","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1080\/17453674.2016.1250480","article-title":"Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture.","volume":"88","author":"Kristensen","year":"2017","journal-title":"Acta Orthop"},{"issue":"4","key":"zoi231483r19","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1302\/0301-620X.98B4.36626","article-title":"The surgical approach for hemiarthroplasty does not influence patient-reported outcome: a national survey of 2118 patients with one-year follow-up.","volume":"98-B","author":"Leonardsson","year":"2016","journal-title":"Bone Joint J"},{"issue":"6","key":"zoi231483r20","first-page":"e194","article-title":"Abductor muscle function and trochanteric tenderness after hemiarthroplasty for femoral neck fracture.","volume":"30","author":"Sayed-Noor","year":"2016","journal-title":"J Orthop Trauma"},{"issue":"1","key":"zoi231483r21","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3109\/17453674.2014.885356","article-title":"Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients.","volume":"85","author":"Rogmark","year":"2014","journal-title":"Acta Orthop"},{"issue":"11","key":"zoi231483r22","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1007\/s00264-012-1624-4","article-title":"Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases.","volume":"36","author":"Biber","year":"2012","journal-title":"Int Orthop"},{"issue":"3","key":"zoi231483r23","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1177\/1457496917748226","article-title":"Lateral and posterior approaches in hemiarthroplasty.","volume":"107","author":"Hongisto","year":"2018","journal-title":"Scand J Surg"},{"key":"zoi231483r15","doi-asserted-by":"crossref","DOI":"10.1002\/9780470316696","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin","year":"1987"},{"key":"zoi231483r12","unstructured":"Euroqol. EQ-5D. Accessed December 5, 2023. https:\/\/euroqol.org\/"},{"key":"zoi231483r14","unstructured":"Lu? Y, Scharfstein? DO, Brooks? MM, Quach? K, Kennedy? EH. Causal inference for comprehensive cohort studies.? arXiv. Preprint posted online October 8, 2019. doi:10.48550\/arXiv.1910.03531"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2813843\/tol_2024_oi_231483_1704316016.9216.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T16:00:46Z","timestamp":1704988846000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2813843"}},"subtitle":["A Randomized Clinical Trial Alongside a Natural Experiment"],"short-title":[],"issued":{"date-parts":[[2024,1,11]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.50765","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,11]]}}}