{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:15:48Z","timestamp":1765880148873,"version":"3.48.0"},"reference-count":19,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies on definitive outcomes, including pain, functional recovery, and complication rates, are notably lacking. This systematic review and meta-analysis aim to address this critical gap by meticulously comparing these approaches with long-term follow-up. Methods: A systematic literature search was performed, including only comparative studies with a minimum 1-year follow-up. A meta-analysis was performed for the primary outcome measures: operative time, dislocations, infections, perioperative fractures and reoperations. Secondary outcomes included a qualitative synthesis of patient-reported outcomes (quality of life, pain, and satisfaction). Methodological quality was assessed using RoB 2.0 for randomized controlled trials and MINORS criteria for cohort studies. Results: Our meta-analysis provides robust quantitative evidence. The direct lateral approach is associated with a significantly lower risk of post-operative dislocations (I2 = 58%; OR = 2.86, 95% CI: 2.53 to 3.22; p &lt; 0.00001) and a significantly lower rate of reoperation (I2 = 0%; OR = 1.25, 95% CI: 1.12 to 1.40; p = 0.0001) compared to postero-lateral approach. Operative time, infection, and perioperative fracture rates were found to be statistically comparable. However, patient-reported outcomes yielded inconsistent results across studies, often becoming non-significant after adjusting for confounders. Conclusions: This meta-analysis shows that the direct lateral approach is associated with lower rates of dislocation and reoperation compared with the postero-lateral approach, while patient-reported outcomes remain variable across studies. Further high-quality comparative trials are needed to confirm these associations and guide surgical decision-making.<\/jats:p>","DOI":"10.3390\/jcm14248846","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:57:24Z","timestamp":1765879044000},"page":"8846","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Surgical Approach on Mid-Term Clinical Outcomes Following Hemiarthroplasty for Femoral Neck Fractures: A Systematic Review and Meta-Analysis of Postero-Lateral Versus Direct Lateral Approaches"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8460-5078","authenticated-orcid":false,"given":"Gianmarco","family":"Marcello","sequence":"first","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"},{"name":"Orthopaedics and Traumatology Unit, Ospedale dei Castelli, Via Nettunense, Km 11\/5, 00040 Ariccia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2637-3668","authenticated-orcid":false,"given":"Francesco Rosario","family":"Parisi","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4268-5186","authenticated-orcid":false,"given":"Lorenzo Alirio","family":"Diaz Balzani","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9203-2918","authenticated-orcid":false,"given":"Alessandro","family":"Del Monaco","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Zappal\u00e0","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4140-738X","authenticated-orcid":false,"given":"Giuseppe Francesco","family":"Papalia","sequence":"additional","affiliation":[{"name":"Oncological Orthopaedics Department, IFO-IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Capperucci","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2993-2181","authenticated-orcid":false,"given":"Erika","family":"Albo","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0929-3586","authenticated-orcid":false,"given":"Augusto","family":"Ferrini","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9318-4114","authenticated-orcid":false,"given":"Biagio","family":"Zampogna","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del 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Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco","family":"Papalia","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00198-023-06907-3","article-title":"Global burden of hip fracture: The Global Burden of Disease Study","volume":"35","author":"Feng","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1302\/0301-620X.98B3.36515","article-title":"Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients","volume":"98-B","author":"Rogmark","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Shuai, L., Huiwen, W., Shihao, D., Fangyuan, W., Juehua, J., and Jun, L. (2022). A comparison of different surgical approaches to hemiarthroplasty for the femoral neck fractures: A meta-analysis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1049534"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Filippini, M., Bortoli, M., Montanari, A., Pace, A., Di Prinzio, L., Lonardo, G., Parisi, S.C., Persiani, V., De Cristofaro, R., and Sambri, A. (2023). Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis. 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