As the average human lifespan increases, activity levels increase, and the incidence of osteoporosis increases, so does the incidence of femoral neck fractures. In the past, the criteria for selecting a treatment plan for femoral neck fractures was based on whether the fracture fragment was displaced or not. When the fracture mass was relatively nondisplaced, internal fixation was the treatment of choice; when the fracture mass was significantly displaced, we favored hemiarthroplasty (HA). Total hip arthroplasty, on the other hand, is rarely used, due to its higher chance of hip dislocation after surgery. However, with recent studies showing better recovery of hip function and low revision rates, total hip arthroplasty has become increasingly popular with operators and patients. Furthermore, the increased diameter of the femoral head of the prosthesis, the use of high cross-linked polyethylene and the design of the double-acting head have greatly increased the stability of the joint after total hip replacement. The goal of the surgery is simple: to restore the patient’s hip function to the preoperative level as much as possible, while also ensuring a much lower complication rate. Although the majority of hip fracture patients are older than 75
Although most hip fracture patients are older than 75 years, their medical history is not identical, ranging from the frail to the robust to patients with Alzheimer’s disease. Therefore, we need a complete treatment strategy to choose the most appropriate treatment option. However, before making a decision, we should be clear: What is the patient’s preoperative level of function and activity? What diseases does the patient have? Will the patient comply with medical advice, e.g., partial postoperative weight-bearing activities? Internal fixation is commonly used in young adults with nondisplaced femoral neck fractures (Figure
1), which preserves the patient’s hip joint intact and is less traumatic. However, fracture healing time is longer after internal fixation and there is a risk of arthritis or osteoporosis and loosening of the internal fixation. Immediate postoperative weight bearing and good functional recovery of the hip are the advantages of total hip replacement, but postoperative dislocation and surgical trauma can occur. The authors concluded that the indications for total hip arthroplasty include preexisting osteoarthritis and displaced fractures in elderly patients. However, do young patients with displaced femoral neck fractures also need total hip replacement and should older patients undergo THR or HA?
Therefore, by reviewing the previous literature, the authors have summarized the following treatment strategy for displaced femoral neck fractures. When operators consider arthroplasty for displaced femoral neck fractures, the literature suggests that patients recover well from hip function after THR and have a low rate of postoperative reoperation. However, the incidence of joint dislocation is higher than that of
Therefore, for patients with cognitive impairment, the authors recommend unipolar or bipolar hemiarthroplasty.