***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To determine the mortality risk following hip fracture and identify factors predictive of increased mortality . Design Retrospective review of prospect ively collected data . Setting Tertiary care orthopaedic hospital . Background Approximately 250,000 hip fractures occur annually in the United States . The greatest mortality risk following hip fracture has been demonstrated to be within the first 6 months of fracture , and some studies report that the risk approaches expected mortality after 6 months . However , more recent studies have demonstrated that an increased risk of mortality may persist for several years postfracture . The purpose of this study was to assess the excess mortality associated with hip fracture at up to 2 years postinjury . Methods All patients with a hip fracture who were admitted to our institution over a 10-year period were evaluated . Criteria for inclusion included : Caucasian , age 65 or older , previously ambulatory , and home dwelling . Patients were followed prospect ively to determine the mortality risk associated with hip fracture over a 2-year follow-up period . Mortality was compared to a st and ardized population and st and ardized mortality ratios were calculated . Results Eight hundred thirty-six patients met the inclusion criteria and were included .  The mortality risk was highest within the first 3 months following fracture , with st and ardized mortality ratios approaching that of the control population by two years . Patients age 65–84 had higher mortality risk when compared with patients age ≥85 . American Society of Anesthesiologists classification was predictive of increased mortality risk in younger patients , with these patients having triple the mortality risk when compared to the reference population at 2-year follow-up . More elderly patients had minimal excess mortality associated with hip fracture at 1- and 2-year follow-up , regardless of ASA classification . Conclusion The data demonstrate that hip fracture is not associated with significant excess mortality amongst patients older than age 85 . Amongst younger patients , however , those with ASA classifications of 3 or 4 have significant excess mortality following hip fracture that persists up to 2 years after injury Purpose A primary arthroplasty constitutes a st and ard procedure in the treatment of patients with displaced fractures of the femoral neck . Although dislocation of the prosthesis remains a significant clinical problem , there are no previous reports on its influence on health-related quality of life ( HRQoL ) . We analysed how a dislocation of the hip arthroplasty influenced the patients ’ HRQoL. Methods In total 319 consecutive patients with a displaced fracture of the femoral neck treated with a primary arthroplasty were included in a prospect i ve cohort study . We used a mixed-effects model regression analysis to evaluate factors of importance for HRQoL ( EQ-5Dindex score ) during the first 12 months following surgery . Results A dislocation of the arthroplasty occurred in 21 of the 319 patients ( 7 % ) , 8 of whom had a single dislocation and 13 recurrent dislocations . At 4 months , the EQ-5Dindex score displayed a significantly worse outcome for patients with recurrent dislocations compared to patients with no dislocation ( P = 0.001 ) , and a trend towards a worse outcome for patients with a single dislocation ( P = 0.08 ) . At 12 months , the mean EQ-5Dindex score of patients with recurrent dislocations was still substantially lower ( P = 0.001 ) , while the EQ-5Dindex score for patients with a single dislocation had returned to a level similar to that of patients with no dislocation . Our analysis of the EQ-5D dimensions indicates that the difference was mainly due to perceived difficulties in self-care and usual activities and increased problems with anxiety/depression . Conclusions A recurrent dislocation of the hip arthroplasty in the treatment of patients with femoral neck fractures seems to result in a persisting deterioration in the HRQoL , while patients with a single dislocation seem to experience only a temporary deterioration Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIMS Hemiarthroplasty of the hip is usually carried out through either a direct lateral or posterior approach . The aim of this prospect i ve observational study was to determine any differences in patient-reported outcomes between the two surgical approaches . PATIENTS AND METHODS From the Swedish Hip Arthroplasty Register we identified patients of 70 years and above who were recorded as having had a hemiarthroplasty during 2009 . Only patients who had been treated with modern prostheses were included . A question naire was posted to those who remained alive one year after surgery . A total of 2118 patients ( 78 % of those available ) with a mean age of 85 years ( 70 to 102 ) returned the question naire . RESULTS Patients who had undergone surgery through a posterior approach  reported a higher health-related quality of life ( HRQoL , EQ-5D mean 0.52 versus 0.47 , p = 0.009 ) , less pain ( visual analogue scale mean 17 versus 19 , p = 0.02 ) and greater satisfaction with the result of surgery ( visual analogue scale mean 22 versus 24 , p = 0.02 ) than those who had a direct lateral approach . However , after adjusting for age , gender , cognitive impairment and American Society of Anesthesiologists grade , no association was found between surgical approach and HRQoL , residual pain or patient satisfaction . TAKE HOME MESSAGE The surgical approach for hemiarthroplasty does not seem to affect the patient-perceived HRQoL , residual pain or patient satisfaction one year after surgery on elderly patients . The choice of approach should be based on other factors , such as the risk of dislocation Background and purpose — The direct anterior ( DA ) approach in total hip arthroplasty has recently been associated with faster functional recovery than the posterolateral ( PL ) approach . We hypothesized that the same should hold for the DA approach in bipolar hemiarthroplasty for femoral neck fractures . Patients and methods — 82 patients with a displaced femoral neck fracture and c and i date s for bipolar hemiarthroplasty  were enrolled after IRB approval in this prospect i ve non-r and omized comparative study ( DA : n = 38 ; PL : n = 44 ) . The postoperative protocol s were similar in both groups . Evaluation included surgical complications , component placement , and early functional outcomes , assessed 6 weeks postoperatively using a timed up- and -go ( TUG ) test . The incidence of dislocation was assessed by telephone interview at least 1 year after the surgery . Results — The DA-group patients had better results in the TUG test than the PL-group patients 6 weeks after surgery : half were under 19 seconds as opposed to only one third for PL ( p = 0.06 ) . We did not record any intraoperative femoral fracture or any lateral femoral cutaneous neuropraxia in the DA group . We observed a significant difference ( p = 0.04 ) in lateral offset between the PL group ( 4.2 ( SD 6.4 ) mm ) and the DA group ( −1.6 ( SD 8.5 ) mm ) . Stem alignment was similar between groups . The dislocation rate for DA patients was lower than for PL patients ( 1 of 38 cases vs. 9 of 44 cases ; p = 0.02 ) . Interpretation — Our findings indicate that relative to the posterolateral approach , the direct anterior approach for bipolar hemiarthroplasty may improve gait in the early postoperative period and decrease the dislocation rate Background A minimal invasive approach for elective hip surgery has been implemented in our institution in the past . It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery . Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma . Methods Sixty patients who sustained a fractured neck of femur were r and omly assigned into two groups . In the minimal invasive arm , the so called “ direct anterior approach ” ( DAA ) was chosen , in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty . Primary outcome parameter was the mobility as measured by the four-item-Barthel index . Secondary outcome parameters included pain , haemoglobin-levels , complications , duration of surgery , administration of blood transfusion and external length of incision . Radiographs were evaluated . Results A statistically significant difference ( p = 0,009 ) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day , favouring the DAA . Evaluation of the intensity of pain with a visual analogue scale ( VAS ) showed a statistically significant difference ( p = 0,035 ) at day 16 . No difference was evident in the comparison of radiographic results . Conclusions Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur , it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index , there is less pain as measured using the VAS . There is no radiographic evidence that a minimal invasive technique leads to inferior implant position . Level of Evidence : Level II therapeutic study Background Minimally invasive surgery ( MIS ) can lead to early recovery , but its postoperative effect is short after total hip arthroplasty for osteoarthritis . Because bipolar hemiarthroplasty ( BHA ) for femoral neck fractures is preferred for elderly patients , early functional recovery may prevent the rapid progression of disuse atrophy , and an MIS surgical approach may improve subsequent hip joint function . Methods MIS-BHA was performed using the direct anterior approach , without muscle or tendon detachment . A total of 83 patients who underwent BHA from April 2007 to February 2009 were assigned to MIS-BHA or conventional BHA . Selection of patients for MIS-BHA was not r and omized . Hip joint function was evaluated with the Hospital for Special Surgery ( HSS ) system at 1 month and 1 year after surgery . Results There were no significant differences in age , sex , height , weight , body mass index , time from admission to surgery , or preinjury HSS scores between two groups . HSS scores were higher with MIS-BHA ( 24.2 vs. 20.2 ; P = 0.01 ) at 1 month but were similar 1 year after surgery ( 29.9 vs. 27.2 ; P = 0.10 ) . Conclusions The effectiveness of MIS-BHA for femoral neck fracture is limited to the early postoperative period . Therefore , MIS-BHA does not appear to be appropriate for treatment of femoral neck fractures A series of 531 patients presenting with a displaced subcapital femoral fracture treated by hemiarthroplasty  , were studied prospect ively to determine the optimal approach for surgery . A total of 302 prostheses were inserted by an anterolateral approach and 229 by a posterolateral approach .  Complications in these two broadly comparable groups are discussed . Dislocation and thrombosis were more common after a posterior approach . Operative time , blood loss , and infection , were greater after an anterior approach . There was no significant difference in the length of hospital stay or mortality . Our findings suggest that favoured approach should be that at which the surgeon feels more competent BACKGROUND Controversy exists regarding the use of cement for hemiarthroplasty to treat a displaced subcapital femoral neck fracture in elderly patients . The primary hypothesis of this study was that use of cement would provide better visual analog pain scores following this procedure in an elderly patient population . METHODS Elderly patients ( at least seventy years of age ) without severe cardiopulmonary compromise who presented to one institution with a displaced subcapital femoral neck fracture were offered inclusion in the study . One hundred and sixty patients ( mean age , eighty-five years ) with an acute displaced femoral neck fracture were r and omly allocated to hemiarthroplasty with either a cemented Exeter or an uncemented Zweymüller Alloclassic component . Clinical and radiographic follow-up was performed for two years and the outcomes were recorded by a blinded assessor . The main clinical outcome measures were pain , mortality , mobility , complications , reoperations , and quality of life measured with use of vali date d instruments . RESULTS The mean visual analog pain score at rest did not differ significantly between the groups . The total number of complications was greater in the uncemented group ( sixty-three compared with twenty-eight in the cemented group ) . Subsidence was significantly more common in the uncemented group ( eighteen compared with one in the cemented group ) . Intraoperative or postoperative fracture was also significantly more common in the uncemented group ( eighteen compared with one in the cemented group ) . The mortality rate did not differ significantly between the groups at any time point ( thirty-five deaths in the uncemented group compared with thirty-two in the cemented group at two years ) . The Oxford hip score was significantly poorer in the uncemented group at six weeks ( 38.8 compared with 35.7 in the cemented group ) , and it was also poorer or similar at later follow-up time points although the differences were not significant . There was also a trend toward poorer mobility and greater dependence on walking aids in the cemented group . The postoperative Short Musculoskeletal Function Assessment and Mini-Mental State Examination scores did not differ significantly between the groups . CONCLUSIONS In elderly patients ( seventy years or older ) without severe cardiopulmonary compromise who were treated with hemiarthroplasty for a displaced femoral neck 
    Output:
    
DAA had a significantly lower dislocation rate compared to posterior capsular approaches .
Conclusion This is the first systematic review and meta- analysis of the DAA for hemiarthroplasty .
Available evidence suggests superior early functional mobility with the DAA .
The DAA is associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty