Total Hip Arthroplasty Versus Bipolar Hemiarthroplasty for Treatment of Intracapsular Displaced Fracture Neck Femur in Elderly Active Patients

Total Hip Arthroplasty Versus Bipolar Hemiarthroplasty for Treatment of Intracapsular Displaced Fracture Neck Femur in Elderly Active Patients; Single-center Randomized Controlled Trial

Femoral neck fracture (FNF) is a worldwide health problem that can cause significant morbidity and mortality. Most femoral neck fractures are associated with a fall, and the risk factors include osteoporosis, chronic medication use, and reduced level of activity.

Femoral neck fractures are among the most common injuries in the elderly, and their number continues to increase with a more aged population.

In the elderly, femoral neck fractures may lead to significant mortality and morbidity, with impaired mobility and loss of independence. Given their high incidence and associated detrimental effects on patient lives.

The femoral neck fracture is a major type of hip fracture, whose treatment includes internal fixation, hemiarthroplasty (HA), or total hip arthroplasty (THA). The decision depends on multiple variables, including fracture pattern, surgeon comfort, and the patient's age, health, and ambulatory status. Internal fixation is a preferred management option for young people or the elderly who are intolerant of prosthesis surgery. THA and HA are widely used in displaced femoral neck fractures in the elderly. Surgery in these patients is undertaken to facilitate nursing and provide timely pain relief, rapid mobilization, and accelerated rehabilitation In general, HA has the advantages of shorter operation time, less blood loss, less technical demand, less economic burden, and a lower dislocation rate. However, some patients treated with HA require conversion to THA due to complications such as acetabular erosion.

THA, on the other hand, has been associated with superior patient satisfaction and better hip function, less acetabular erosion, and a lower revision rate. However, increased surgical complexity, operation time, and blood loss, as well as higher dislocation rates in THA for FNFs, remain a concern

Inclusion Criteria:

• were aged ≥ 65 years
• with a displaced intracapsular fracture of the femoral neck (Garden type III, IV).

Exclusion Criteria:

• extracapsular fracture of the femoral neck
• Pathological fractures, or open fractures
• Active infections at or near the hip joints.
• bedridden, immobile, or cognitively impaired patients
• patients with associated pelvic or acetabular fractures