Chinese expert consensus on the surgical treatment of femoral neck fracture by direct anterior approach hip arthroplasty for elderly patients (2025 edition)

TL;DR

This paper presents a new expert consensus on using the direct anterior approach for hip arthroplasty in elderly patients with femoral neck fractures, aiming to standardize surgical practices and improve outcomes.

Contribution

The paper introduces a unified expert consensus with 12 clinical recommendations for DAA-HJA in geriatric femoral neck fracture patients.

Findings

A multidisciplinary panel developed 12 evidence-based recommendations for DAA-HJA in elderly FNF patients.

Recommendations cover surgical indications, approach selection, anesthesia, and postoperative care.

The consensus includes strong, moderate, and limited strength recommendations to guide clinical practice.

Abstract

Geriatric femoral neck fracture (FNF) represents a pressing global health challenge, imposing substantial burdens on medical resources while being associated with high complication rates and suboptimal clinical outcomes. In recent years, the direct anterior approach (DAA) has emerged as a mainstream surgical strategy for hip joint arthroplasty (HJA) in developed countries, owing to its minimally invasive nature, neuromuscular-sparing anatomical interval, preservation of soft tissue integrity, and alignment with enhanced recovery after surgery principles, collectively contributing to significant improvements in clinical outcomes of HJA for elderly patients with FNF. However, no unified consensus exists regarding standardized techniques and procedural protocols for DAA-HJA in this specific patient population. Consequently, there is an urgent need to develop an evidence-based expert consensus to address key clinical dilemmas inherent to DAA-HJA in geriatric FNF. Sponsored by the Joint Surgery Group of the Chinese Medical Association, this expert consensus builds upon the foundational Chinese Expert Consensus on Direct Anterior Approach Hip Arthroplasty for the Surgical Treatment of Geriatric Femoral Neck Fracture (2023 Edition). A multidisciplinary expert panel was convened to standardize core issues and procedural norms for DAA-HJA in geriatric FNF. Two rounds of modified Delphi questionnaires and one consensus conference were conducted for voting, with a predefined consensus threshold of ≥ 70%. A total of 12 clinical recommendations were formulated, covering critical concerns including surgical indications, approach selection, operative timing, anesthesia management, patient positioning, prosthesis choice, fixation methods, drainage strategies, postoperative mobilization, and the application of navigation/robotic technologies. These recommendations are stratified by strength: Recommendations 4, 8, and 12 are classified as strong; Recommendations 1, 3, 5, and 9 are moderate; and Recommendations 2, 6, 7, 10, and 11 are limited. By providing systematic, evidence-based, and operationally feasible guidance for the clinical application of DAA in geriatric FNF, this consensus aims to promote standardized, systematic, and individualized diagnosis and treatment paradigms—ultimately optimizing patients’ functional prognosis.

Video Abstract

Video Abstract

The online version contains supplementary material available at 10.1186/s42836-026-00368-9.

Figures