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

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.

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Publication Details

Journal
Arthroplasty
Published
2026-02-13
DOI
https://doi.org/10.1186/s42836-026-00368-9
Primary Topic
Hip and Femur Fractures
Type
article
Field-Weighted Citation Impact
0.00

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article

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

N BAO, Zhaxi Mima, Xiaojun Man, Eryou Feng et al.
Arthroplasty
Hip and Femur Fractures
article

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

N BAO, Zhaxi Mima, Xiaojun Man, Eryou Feng, M. X. Luo, Shenghu Zhou, Li Xiong, Luobu ZhaXi, Xiaofeng Li, Dawei Zhang, Weihua Xu, Xiaohu Liu, Zongke Zhou, Guangxing Chen, Yuehua Chen, Chuan He, Baoyi Liu, Fei Luo, Shuo Geng, Jie Xie, Wenwei Qian, Bo Wu, Xinzhan Mao, Hu Li, Jinmei Awang, Huiwu Li, Yuanchen Ma, Pingyue Li, K Wang, Boyong Xu, X Q He, Yixin Zhou, Z H Xu, Zhidong Cao, Zhen Zhang, Feng Xie, Wei Wang, Xiaorui Cao, Mao Nie, Yuan Zhang, Pei Yang, Wei Huang, Jie Li, Li Cao, Xiaogang Zhang, Jun Zhang, Xia Zhang, Ye Ye, Hao Tang, Guodong Liu, Wei Chai, Ning Hu, Hui Li, Weiguo Wang, Guoqiang Zhang, Min Wang, Li Sun, Yan Xiong
article en

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.

ArthroplastyVol. 8(1)
University of Science and Technology of China (CN), Fujian Medical University (CN), Union Hospital (HK), Central South University (CN), Nanchang University (CN), Army Medical University (CN), Xinjiang Medical University (CN), Harbin Medical University (CN), Shanghai Jiao Tong University (CN), Dalian Medical University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Peking University (CN), Sichuan University (CN), Nanjing General Hospital of Nanjing Military Command (CN), China-Japan Friendship Hospital (CN), Peking Union Medical College Hospital (CN), Ruijin Hospital (CN), First Affiliated Hospital of Xinjiang Medical University (CN), Chinese PLA General Hospital (CN), Beijing Jishuitan Hospital (CN), West China Hospital of Sichuan University (CN), Daping Hospital (CN), Shanghai Ninth People's Hospital (CN), Shiga University of Medical Science Hospital (JP), Second Affiliated Hospital of Chongqing Medical University (CN), Xi'an Honghui Hospital (CN), General Hospital of Guangzhou Military Command (CN), Second Affiliated Hospital of Dalian Medical University (CN), People's Liberation Army 401 Hospital (CN), Second Affiliated Hospital of Inner Mongolia Medical University (CN), 82th Hospital of Pla (CN), Third People 's Hospital of Chongqing (CN), Xinqiao Hospital (CN), Sichuan Cancer Hospital (CN), Peking University People's Hospital (CN), The Affiliated Yongchuan Hospital of Chongqing Medical University (CN), Southwest Hospital (CN), Second Affiliated Hospital of Xi'an Jiaotong University (CN), Second Affiliated Hospital of Harbin Medical University (CN), Tibet Autonomous Region People's Hospital (CN), Chongqing Emergency Medical Center (CN), Sichuan Provincial Hospital of Traditional Chinese Medicine (CN), First Affiliated Hospital of Dalian Medical University (CN), Shanghai Sixth People's Hospital (CN), Affiliated Zhongshan Hospital of Dalian University (CN), Second Xiangya Hospital of Central South University (CN), Guangdong Provincial People's Hospital (CN), Guizhou Provincial People's Hospital (CN), Xijing Hospital (CN), Union Hospital (CN), First Affiliated Hospital of Nanchang University (CN), First Affiliated Hospital Zhejiang University (CN), Huazhong University of Science and Technology (CN), Chongqing Medical University (CN)
Chinese Medical Association, Army Medical University, Chinese People’s Liberation Army, National Health Commission of the People's Republic of China
Partnerships for the goals
Openalex Percentile: Top 57%
Hip and Femur Fractures
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