COMPARATIVE FUNCTIONAL OUTCOME ASSESSMENT: TOTAL HIP ARTHROPLASTY VERSUS HEMIARTHROPLASTY IN CASES OF DISPLACED INTRACAPSULAR NECK OF FEMUR FRACTURE IN >65 YEARS

Abstract

Fractures of the femoral neck predominantly occur in the elderly due to low-energy
falls and are often linked with osteoporosis. In contrast, femoral neck fractures in the
young usually result from high-energy trauma and require different treatment
approaches. These fractures are typically intracapsular, risking the blood supply to
the femoral head. The study is to assess the functional and clinical outcomes of Total
Hip Arthroplasty (THR) versus Hemiarthroplasty (HA) in displaced intracapsular
femoral neck fractures in patients over 65 years old and to evaluate intraoperative
and postoperative complications. This prospective study was conducted at T D Govt
Medical College Hospital, Alappuzha, over one year after obtaining clearance from
the Institutional Ethics Committee. Fifty patients over 65 years with displaced
intracapsular femoral neck fractures, scheduled for either THR or HA, were enrolled
after informed consent.
Patients were assessed preoperatively, at 10 days, 1 month, 3 months, and 6 months
postoperatively using the Harris Hip Score for functional outcome and radiological
evaluation with a pelvis and bilateral hip AP view on X-ray. Most patients
undergoing THR (40%) and HA (64%) were aged 65-70 years. Females constituted
56% of THR and 52% of HA cases. Right-sided fractures were more common,
accounting for 56% in THR and 52% in HA. Falls were the cause in 84% of both
groups, and 60% of fractures were classified as Garden stage 4. No complications
were observed in 56% of THR and 60% of HA cases, though periprosthetic fractures
were noted in HA. The majority of surgeries (76% of THR and
84% of HA) were completed in less than 120 minutes. THR showed 40% excellent,
44% good, and 16% fair outcomes, while HA showed 12% excellent, 36% good,
48% fair, and 4% poor outcomes.