Publication:

Hemiarthroplasty versus total hip replacement in displaced femoral neck fractures among the elderly: a prospective comparative study

Background Displaced femoral neck fractures in elderly patients are associated with high morbidity, impaired mobility, and reduced quality of life. Although arthroplasty is the preferred treatment, the choice between hemiarthroplasty and total hip replacement remains debated. This study aimed to compare their functional outcomes, perioperative parameters, complications, and overall clinical results.

Methods This prospective comparative study included 60 elderly patients with displaced intracapsular femoral neck fractures. Patients were divided into two equal groups: group A underwent hemiarthroplasty and group B underwent total hip replacement. Baseline demographic variables, comorbidities, operative time, intraoperative blood loss, transfusion requirement, hospital stay, mobilization time, complications, reoperation, mortality, and Harris hip score (HHS) were assessed during follow-up at 1, 3, 6, and 12 months.

Results Baseline characteristics and comorbidities were comparable between the two groups. Hemiarthroplasty was associated with significantly shorter operative time than total hip replacement, 72.43±12.85 minutes versus 98.66±15.32 minutes, respectively (p<0.001). Mean intraoperative blood loss was also significantly lower in the hemiarthroplasty group, 286.75±74.52 ml compared with 421.33±96.25 ml in the total hip replacement group (p<0.001). Blood transfusion requirement was significantly lower after hemiarthroplasty than after total hip replacement, 26.7% versus 53.3% (p=0.035). Total hip replacement demonstrated significantly better HHS at 3 months (75.86±7.64 versus 70.53±8.22; p=0.012), 6 months (84.62±6.84 versus 77.95±7.56; p=0.001), and 12 months (89.15±6.46 versus 81.33±7.27; p=0.001). Excellent or good outcome was achieved in 83.3% of total hip replacement patients compared with 63.3% of hemiarthroplasty patients. Acetabular erosion was significantly more common after hemiarthroplasty, 13.3% versus 0.0% (p=0.0384).

Conclusions Total hip replacement provides better functional recovery in active, medically fit elderly patients, whereas hemiarthroplasty offers perioperative advantages and remains suitable for frail or low-demand patients. Procedure selection should be individualized.