Comparison of short- to mid-term outcomes between DAA hemiarthroplasty and PFNA internal fixation in elderly patients with trochanteric fractures: a propensity score-matched retrospective study
- 1epartment of Orthopaedic Surgery, Jingjiang People’s Hospital Affiliated to Yangzhou University, Taizhou, Jiangsu, China
Abstract
BackgroundTrochanteric fractures (TF) are common in elderly patients. Although Proximal Femoral Nail Antirotation (PFNA) internal fixation is widely used, hemiarthroplasty via the direct anterior approach (DAA) has attracted increasing interest because of concerns regarding prolonged bed rest and associated complications. This study compares early outcomes of DAA hemiarthroplasty vs. PFNA internal fixation in elderly TF patients.MethodsPatients aged ≥75 years with TF treated between January 2018 and January 2024 were retrospectively reviewed. After application of the inclusion and exclusion criteria, 54 patients who underwent DAA hemiarthroplasty were identified. To minimize selection bias, 1:1 propensity score matching was performed based on age, sex, body mass index (BMI), fracture type, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) grade, yielding 54 matched patients who received PFNA. Outcomes included operative duration, blood loss, incision length, bedridden duration, Harris Hip Scores (HHS) at 1, 3, 6, 12, and 24 months, complications, and radiographic findings.ResultsAfter matching, baseline characteristics were well balanced between the two groups. The PFNA group had significantly less blood loss (220.3 vs. 349.6 mL, P < 0.001) and a shorter operative time (40.05 vs. 75.02 min, P < 0.001), but a longer total incision length (11.49 vs. 9.29 cm, P < 0.001). Bedridden duration was markedly shorter in the DAA group (0.99 vs. 52.86 days, P < 0.001). At all follow-up points, HHS was significantly higher in the DAA group (1 month: 78.85 vs. 63.89, P < 0.001; 24 months: 92.03 vs. 82.86, P < 0.001). Complication rates were lower in the DAA group, although the difference did not reach statistical significance. Mean prosthesis subsidence in the DAA group was 2.7 mm.ConclusionIn this propensity score-matched retrospective study, DAA hemiarthroplasty was associated with faster early functional recovery and a shorter bedridden duration than PFNA internal fixation in elderly patients with TF, but also with a longer operative time and greater blood loss. The substantial difference in postoperative rehabilitation protocols between the two groups may have contributed to the observed gap in functional outcomes.Study designLevel of evidence, 3.
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BibTeX
@article{jia2026comparison,
title = {{Comparison of short- to mid-term outcomes between DAA hemiarthroplasty and PFNA internal fixation in elderly patients with trochanteric fractures: a propensity score-matched retrospective study}},
author = {Yanfeng Jia and Liqun Xu and Hongwei Bao and Jingzhao Hou and Zhao Wang},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1954682},
url = {https://doi.org/10.3389/fsurg.2026.1954682},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparison of short- to mid-term outcomes between DAA hemiarthroplasty and PFNA internal fixation in elderly patients with trochanteric fractures: a propensity score-matched retrospective study
AU - Yanfeng Jia
AU - Liqun Xu
AU - Hongwei Bao
AU - Jingzhao Hou
AU - Zhao Wang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1954682
UR - https://doi.org/10.3389/fsurg.2026.1954682
AB - BackgroundTrochanteric fractures (TF) are common in elderly patients. Although Proximal Femoral Nail Antirotation (PFNA) internal fixation is widely used, hemiarthroplasty via the direct anterior approach (DAA) has attracted increasing interest because of concerns regarding prolonged bed rest and associated complications. This study compares early outcomes of DAA hemiarthroplasty vs. PFNA internal fixation in elderly TF patients.MethodsPatients aged ≥75 years with TF treated between January 2018 and January 2024 were retrospectively reviewed. After application of the inclusion and exclusion criteria, 54 patients who underwent DAA hemiarthroplasty were identified. To minimize selection bias, 1:1 propensity score matching was performed based on age, sex, body mass index (BMI), fracture type, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) grade, yielding 54 matched patients who received PFNA. Outcomes included operative duration, blood loss, incision length, bedridden duration, Harris Hip Scores (HHS) at 1, 3, 6, 12, and 24 months, complications, and radiographic findings.ResultsAfter matching, baseline characteristics were well balanced between the two groups. The PFNA group had significantly less blood loss (220.3 vs. 349.6 mL, P < 0.001) and a shorter operative time (40.05 vs. 75.02 min, P < 0.001), but a longer total incision length (11.49 vs. 9.29 cm, P < 0.001). Bedridden duration was markedly shorter in the DAA group (0.99 vs. 52.86 days, P < 0.001). At all follow-up points, HHS was significantly higher in the DAA group (1 month: 78.85 vs. 63.89, P < 0.001; 24 months: 92.03 vs. 82.86, P < 0.001). Complication rates were lower in the DAA group, although the difference did not reach statistical significance. Mean prosthesis subsidence in the DAA group was 2.7 mm.ConclusionIn this propensity score-matched retrospective study, DAA hemiarthroplasty was associated with faster early functional recovery and a shorter bedridden duration than PFNA internal fixation in elderly patients with TF, but also with a longer operative time and greater blood loss. The substantial difference in postoperative rehabilitation protocols between the two groups may have contributed to the observed gap in functional outcomes.Study designLevel of evidence, 3.
SN - 2296-875X
ER -