Analysis of Clinical Effect after Treatment of Patients with Femoral Neck Fracture Using Total or Hemihip Arthroplasty

Abstract

Objective: To investigate the difference in clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fracture.

Method: To retrospectively analyze 96 patients (96 hips) with femoral neck fracture treated in our hospital and distinguish them into THA group (50 patients with 50 hips) and HA group (46 patients with 46 hips) according to the difference of their chosen surgical procedure, and to compare the difference in perioperative indexes, postoperative hip function, occurrence of near and long-term complications, long-term imaging performance, and revision rate between the two groups.

Result: The operating time, intraoperative blood loss, and total drainage were greater in the THA group than in the HA group (P < 0.05). At 6 months after surgery, the Harris score of the hip joint was higher in the HA group than in the THA group. At 3 years after surgery, the Harris score was higher in the THA group than in the HA group (P < 0.05). At 3 years after surgery, the excellent hip function rates were 86.00% and 67.39% in the THA and HA groups, respectively, with statistically significant difference between the groups. The incidence of long-term complications was significantly lower in the THA group than in the HA group (P < 0.05). The anteversion and abduction angles of patients in the HA group were smaller than those in the THA group at 6 months after surgery (P < 0.05). The WOMAC scores of the THA group were better than those of the HA group at 3 years after surgery (P < 0.05).

Conclusion: Compared with hemiarthroplasty, total hip arthroplasty has a longer operative time and more postoperative bleeding, but the complication rate is relatively lower in the long term, and the patients have better long-term hip function recovery, so total hip arthroplasty is recommended for patients with femoral neck fracture with an expected survival time longer than 3 years.

Figure 1

Comparison of the difference in perioperative clinical indicators between the two groups. Patients in the THA group had greater operative time (a), intraoperative blood loss (b), and total drainage (c) than the HA group, and the difference between the groups were all statistically significant (P < 0.05). The difference between the two groups was not statistically significant (P > 0.05) when comparing the length of hospital stay (d). # represents a statistically significant difference between groups comparing the same index.

Figure 2

Comparison of the difference in the near and long-term hip function scores between the two groups. Patients in the HA group had higher hip Harris scores than the THA group at 6 months postoperatively (P0.05), and at 3 years postoperatively, the THA group had higher Harris scores than the HA group (P0.05) (c), and at 3 years postoperatively, the THA group (a) and HA group (b) had similar hip Harris scores (b). When compared to the within-group pre-post comparison at 6 months postoperatively, the change in scores was statistically significant (P0.05). # denotes a statistically significant difference between groups when comparing the same metric.

Figure 3

Comparison of postoperative imaging performance between the two groups. The anteversion and abduction angles of patients in the HA group were smaller than those in the THA group, and the difference between the groups was statistically significant (P < 0.05). # represents a statistically significant difference between the groups comparing the same index.

Figure 4

Comparison of preoperative and postoperative WOMAC scale scores between the two groups. The difference between the preoperative WOMAC scale scores for each dimension was not statistically significant (P > 0.05), the HA group had lower pain, stiffness, and mobility scores than the THA group at 6 months postoperatively (P < 0.05), the difference between the WOMAC scores for each dimension between the two groups at 1 and 2 years postoperatively was not statistically significant (P > 0.05), and the THA group had better WOMAC scores for each dimension than the HA group at 3 years postoperatively (P < 0.05). The difference between the WOMAC scores of the two groups at 1 and 2 years postoperatively was not statistically significant (P > 0.05), and the THA group had better WOMAC scores than the HA group in all dimensions at 3 years postoperatively (P < 0.05). # represents a statistically significant difference between groups comparing the same index.