To evaluate the stability and clinical effect of lateral decubitus direct anterior approach (DAA) hip replacement in patients with hemiplegia after treatment of Garden type Ⅲ and Ⅳ femoral neck fracture.

A total of 43 patients with femoral neck fracture (Garden type III and IV) combined with hemiplegia admitted to the First Affiliated Hospital of Bengbu Medical College from February 2018 to January 2022 were selected, and divided into 22 patients (13 males and nine females) in DAA group and 21 patients (11 males and 10 females) in posterolateral approach group according to hip replacement surgical approach. The follow-up period was 12 to 26 months. T test, chi square test and rank sum test were used to compare baseline data variance, intraoperative blood loss, operation time, hospital stay, first postoperative movement time, postoperative complications, mobility recovery, visual analoguepain scale (VAS), quality of life score (modified Barthel rating scale) and Harris hip between DAA group and posterolateral approach group Joint function scores and functional recovery of hemiplegic limbs (Brunnstrom stage of hemiplegic function) were used to evaluate the safety and stability of hip replacement with lateral DAA approach in the treatment of femoral neck fractures in hemiplegic patients.

All the patients accpeted completed surgery successfully. DAA group had shorter time for first postoperative exercise, less intraoperative blood loss and shorter length of hospital stay than the posterolateral approach group (t=7.756、6.925、3.479, all P<0.05). Pain (VAS score) was significantly relieved, hip function (Harris score) was improved and quality of life was improved in both groups. The improvement in DAA group was more remarkable than that the posterolateral approach group (t=11.200、-8.429、-11.034、P<0.05, all P<0.05). The stage of Brunnstrom hemiplegia function of lower limbs was significantly improved in both groups after surgery, and the improvement in DAA group was more obvious than the posterolateral approach group (Z=6.747, P=0.009). In the DAA group, 16 cases (72.7%) recovered to the status before surgery, and in the posterolateral approach group, nine cases (42.9%) recovered to the status before surgery (χ²=3.939, P=0.047). There was no significant difference in early complications between the two groups (χ²=0.009, P>0.05).

Lateral DAA approach for hip replacement of Garden Ⅲ and Ⅳ femoral neck fractures with hemiplegia is a safe and effective surgical method with good clinical results.