Hip fracture is one of the major common diseases in the aging population, which is tricky to treat due to the fact that most of the patients are old and frail. Especially for the super old hip fracture patients, it is the key to reduce the mortality rate in the first year of life through appropriate treatment to make the patients resume standing or walking as soon as possible, improve the general function of the patients, and reduce or eliminate the complications of prolonged bed rest. 1, Data and Methods 1.1 Objects The 42 patients in this group were all unilateral hip fractures, aged 85-99 years old, average 92.1 years old, of which 19 were male and 23 were female, all of them fell down accidentally while walking. Among them, there were 27 cases of femoral neck fracture, according to Garden’s typing, there were 18 cases of type III and 9 cases of type IV. Intertrochanteric fractures were 15 cases, according to Evans Jensen[2] , type III 9 cases, type IV 5 cases, type V 1 case.35 patients were suffering from a variety of medical disorders, such as hypertension, coronary heart disease, diabetes mellitus, cerebral thrombosis, chronic bronchitis, obstructive emphysema, pulmonary heart disease, severe osteoporosis, etc. The remaining 7 patients had major medical disorders such as hypertension, coronary artery disease, diabetes, cerebral thrombosis, chronic bronchitis, pulmonary heart disease, severe osteoporosis. The remaining 7 patients had major medical disorders such as severe osteoporosis. Thirty-seven cases of all patients underwent artificial hemiarthroplasty; five cases with fewer medical disorders, strong mobility before injury and life expectancy of more than 8 years underwent artificial total hip replacement. 1.2 Treatment mode 1.2.1 Preoperative: the affected limbs are braked after admission, adequate analgesia (non-steroidal anti-inflammatory drugs) before operation, encourage patients to blow up balloons and other exercises for heart and lung function; actively treat patients’ underlying diseases, actively anti-infective, oxygen, phlegm expectoration and other therapies for patients with pulmonary infections, stabilized control of diabetic patients’ glucose at less than 10 mmol/L, and patients’ hemoglobin <70g/dl. Blood transfusion is needed to correct anemia to ≥90g/dl, and surgery will be performed after the general condition of the patients is stabilized and the indexes are basically back to normal; ultrasonography of lower extremity veins and D-dimer screening are routinely performed on super-elderly patients, and surgery is performed after placing venous filters in patients who have already had venous thrombosis. Preoperative X-rays and trial molding were taken to determine the type of prosthesis, and to anticipate the difficulties of the surgery and the measures to deal with them. Communicate with patients and their families before surgery: inform them of the surgery, anesthesia and postoperative rehabilitation plan, various risks and complications. 1.2.2 Intraoperative: 11 patients were put under general anesthesia, and the remaining 31 cases were operated under lumbar anesthesia, and all the surgeries were performed by the same senior surgeon. The operation was performed by standard small incision posterior lateral approach, and all of them used biologic fixed artificial hip prosthesis (Johnson,Depuy). 1.2.3 Postoperative: after awake from anesthesia, patients were instructed to start moving the ankle joint and isometric contraction of quadriceps; those with poor muscle strength of the lower limbs or more serious mental disorders wore anti-spinning shoes in order to prevent dislocation of the hip joint; 6 hours after the operation, patients began to take oral factor X inhibitors to prevent deep vein thrombosis of the lower limbs once a day until 4 weeks after the operation; all patients had their drainage tubes and urinary catheters removed within 24 hours after the operation; those who were anemic before the operation or whose hemoglobin level was <70% in the postoperative review had their hemoglobin level checked and their hemoglobin level checked again. Blood transfusion was required if the hemoglobin level was <70 g/dl on recheck. Patients with severe osteoporosis should be treated with diphosphonates, calcium tablets, and vitamin D3 for anti-osteoporosis after surgery. Under the condition of good analgesia, patients were encouraged to get out of bed on the 3rd postoperative day with partial weight bearing of the affected limbs, and started to walk with a walker on the 7th postoperative day. The stitches were removed 2 weeks after the operation and then discharged from the hospital. 1.3 Observation indexes: Observe the length of incision, operation time, intraoperative bleeding, incision healing and early functional recovery, whether there are complications such as joint dislocation, incision infection, deep vein thrombosis, postoperative prosthesis subsidence, loosening agent ectopic ossification and so on. The Harris score and VAS score were compared between preoperative and postoperative periods. 2, Results The average length of the surgical incision was 10 cm (7-14 cm), and the average operative time for hemiarthroplasty was 44 minutes, and the average operative time for total hip was 77 minutes. There were 12 cases without intraoperative and postoperative blood transfusion, all of which were patients with femoral neck fracture who had no anemia before surgery and underwent hemiarthroplasty. The remaining 30 patients were transfused, and the average volume of blood transfused in these 30 patients was 400 ml. All patients had no intraoperative or postoperative complications such as fracture, infection and dislocation. Ninety-six percent of the patients were able to go down to the ground 3 days after the operation, and 83% of the patients could walk with the help of a walker 7 days after the operation. One patient died suddenly 3 days after the operation because of pulmonary embolism due to dislodgment of deep vein thrombus. The remaining patients were followed up for an average of 10. 5 months (6-12 months). Six months after the operation, the Harris score was evaluated, with an excellent rate of 76%. In 7 cases of hemiplegia, the functional score decreased due to the influence of muscle strength. 92% of the patients were able to return to their pre-injury walking ability six months after the operation. the average VAS pain score was 4.6 at 3 days after the operation, and all patients did not have any obvious sinking, loosening or heterotopic ossification of the prosthesis during the follow-up period. 3, Discussion 3.1 Super-aged patients refer to elderly patients aged more than 85 years, such patients are often accompanied by cardiovascular system or (and) respiratory system diseases, poor systemic condition and reserve capacity, and experiencing the blow of a hip fracture leads to the recurrence of insidious diseases or aggravation of the original disease, which seriously threatens the patient's life. The treatment of elderly femoral neck fracture with traction requires prolonged bed rest after surgery, and prolonged bed rest is very likely to lead to complications such as decubitus ulcers, pneumonia, cardiovascular and urinary infections, etc., and once a serious complication occurs, the opportunity for surgery will also be lost, thus, generating a vicious circle, which can ultimately lead to the death of the patient. The use of internal fixation surgery can also not avoid a series of serious complications arising from prolonged bed rest. However, the use of artificial joint replacement can avoid the complications caused by long-term bed rest, the patient can get out of bed early and walk with crutches, which greatly shortens the bed rest time of the elderly patients, and can greatly avoid a series of complications brought about by this. Therefore, we believe that as long as the patient can tolerate the surgery, it is advisable to operate as early as possible. For super-aged patients, according to the patient's pre-injury activity level and general condition, we decide whether to perform total hip replacement or hemiarthroplasty; for elderly patients with serious internal diseases, pre-injury activity level is small, and they do not have high requirements for hip activities, and total hip replacement surgery takes a long time, with great trauma and much blood loss after surgery, we generally use hemiarthroplasty. However, the surgical trauma of both total and hemiarthroplasty is large, coupled with the poor basic condition of super-aged patients, the surgical trauma will lead to a series of complications such as postoperative pain, stress reaction, organ function damage, and the risk of thromboembolism, mental trauma and so on, which often require a longer hospitalization time and slow progress of postoperative rehabilitation. By improving a series of measures in the perioperative period, rapid recovery surgery can shorten the average hospitalization time and accelerate the recovery process without increasing the risk of postoperative complications or decreasing the efficacy of surgery. Rapid Recovery Surgery (RRS) refers to the application of a variety of evidence-based methods in the perioperative period to minimize surgical stress and complications, and to achieve lower organ dysfunction, lower mortality, and a better recovery. By developing a set of proven rapid rehabilitation treatment programs and improving the management of patients in the perioperative period, we have been able to provide timely and effective treatment for ultra-elderly hip fracture patients, get them out of bed as early as possible, avoid various serious complications, prolong life expectancy, and improve the quality of life. 3.2 The significance of rapid rehabilitation surgical measures in artificial hip arthroplasty 3.2.1 Obtaining good communication with the patient before the operation, and providing sufficient preoperative education to the patient can reduce anxiety and fear, relieve postoperative pain, make the patient better cooperate with the treatment, and accelerate the postoperative recovery; it is now generally recognized that the nutritional status in the perioperative period is statistically relevant to the rate of complication, medical cost and hospitalization time,. Therefore, it is essential to provide excellent nutrition before surgery. Prolonged preoperative fasting can exacerbate postoperative insulin resistance and elevate blood glucose, which is considered an independent predictor of prolonged postoperative hospitalization. For ultra-high-age artificial joint replacement patients, 200 mL of sugary water can be drunk 2 h before surgery, which can supplement water and energy, reduce the discomfort of preoperative hunger and thirst, improve the patient's ability to tolerate the surgery, and reduce the incidence of postoperative insulin resistance; Effective perioperative analgesia is a key link in the rapid rehabilitation of the surgery, and adequate analgesia is conducive to the patient's early mobility out of bed and to the reduction of the surgical stress response. Producing severe acute pain after artificial hip arthroplasty. Preemptive analgesia (preemptive analgesia), i.e., intervention before the onset of pain, thus preventing or reducing the sensitization of the central nervous system and the afferent sensory injury, to achieve the purpose of reducing postoperative pain, prolonging the duration of analgesia and reducing the demand for analgesics. Commonly used methods of hyperalgesia include epidural analgesia, peripheral nerve block, and local and systemic use of non-steroidal anti-inflammatory drugs, small doses of ketamine or opioids. 3.2.2 When performing rapid recovery surgery, the required anesthesia includes optimizing preoperative medication, providing the best intraoperative conditions, accelerating recovery from anesthesia, avoiding postoperative side effects and early complications, reducing postoperative stress, adequately relieving pain and eliminating discomfort, and accelerating postoperative functional reconstruction. Research results show that local anesthesia and epidural anesthesia are better than general anesthesia to reduce the incidence of postoperative complications and rapid recovery. General anesthesia will not be preferred due to its more complications. In lower extremity surgery, epidural anesthesia can reduce the incidence of postoperative complications in lower extremity surgery by about 30% compared with general anesthesia. Artificial joint replacement surgery small incision technology treatment can reduce soft tissue damage, shorten the operation time, reduce intraoperative bleeding, reduce postoperative pain, shorten hospitalization time, accelerate the patient's postoperative recovery, reduce surgical scar, in 2006 the Chinese Medical Association Orthopaedic Branch of the Joint Surgery Group had a discussion in Shanghai to put 10-12 cm long. The use of minimally invasive small incision technology for super-aged patients can effectively reduce the blow of surgery, so that the affected limb early activity, thus reducing the possibility of deep vein thrombosis as well as pulmonary infarction, and reducing the mortality rate of surgery. However, the small incision technique is not suitable for all patients. In some obese patients and those with a large cervical trunk angle, as well as in those with certain primary deformities, a standard procedure with an enlarged incision may be required. The small incision technique requires the surgeon to have a good grasp of local anatomy and small incision operation techniques in order to successfully complete the surgery, otherwise, it will aggravate the soft tissue injury of the patient. We believe that we should not increase the soft tissue injury of patients in order to purely pursue small incisions, which is contrary to the ultimate goal: minimizing patient trauma, resulting in delayed postoperative recovery. 3.2.3 Postoperative: rehabilitation exercises after arthroplasty are closely related to the final prognosis. Rapid rehabilitation surgery emphasizes early mobility. Early postoperative activities can reduce muscle consumption, enhance cardiopulmonary function, promote the recovery of gastrointestinal function and accelerate the blood circulation of the incision site, promote incision healing and venous return of the lower limbs, prevent the formation of postoperative deep vein thrombosis and reduce the occurrence of postoperative complications. Minimally invasive surgery, optimized anesthesia and good perioperative analgesia used in rapid rehabilitation surgery are all conducive to the early start of patients' activities and rehabilitation training. On the same day after arthroplasty, patients can start to move out of bed under supervision. Early exercise not only reduces the length of time in bed but also improves psychological satisfaction, restores functionality, and accelerates the time to discharge from the hospital. Early activity does not increase the risk of loosening of the prosthesis and failure of bone growth at a later stage. Strengthening nutrition after artificial arthroplasty has a positive effect on accelerating postoperative recovery. Nutrition has a very important role in the recovery of the organism from the blow of surgery. Adequate calcium and vitamin D are essential elements for bone formation, and good nutritional intake can affect the prognosis and time. For most elderly patients, especially for arthroplasty due to fragility fracture, anti-osteoporosis treatment is often needed at the same time to minimize the chance of reoccurrence of fracture. 3.3 Prevention of DVT: Virchow's theory suggests that there are three major elements in the formation of DVT: hypercoagulable state of blood, slow venous blood flow, and endothelial damage. Ultra-high-age patients are often combined with cardiovascular system diseases, diabetes mellitus, hyperlipidemia, etc., and the patients are often due to the preoperative bed for a long period of time, the blood flow of the lower limbs is relatively slow and the blood is in a state of hypercoagulability; surgical trauma, the limbs are stretched for a long time during the operation, twisted, etc., all of which can cause endothelial damage to the blood vessels is an important factor in the development of lower limb deep venous thrombosis. Planes, A, et al. found that after hip arthroplasty, in patients with no DVT detected by vascular imaging and no anticoagulant treatment, 35 days after discharge from the hospital is still a high-risk period for DVT, and the use of enoxaparin can effectively reduce the risk of DVT. In a comparative study, Husted, Henrik found that a combination of short-term pharmacologic anticoagulation and early activity in patients undergoing arthroplasty in a rapid recovery mode reduced the incidence of thromboembolic complications, and Warwick, D, found that patients who did not routinely use anticoagulant medications postoperatively (only during the hospital stay) did not have an increased risk of developing fatal PE, DVT, or other complications of DVT. The 2012 ACCP guidelines for antithrombotic over thromboprophylaxis recommend that all patients undergoing major orthopedic surgery receive prophylaxis with pharmacologic agents or for a minimum IPCD of 10 to 14 days, with extended prophylaxis recommended for 35 days. In patients at increased risk of bleeding, anticoagulation with IPCD or no drugs is recommended. Therefore, for super-elderly patients, we choose to prevent DVT and PE by combining early postoperative activity with pharmacologic anticoagulation during hospitalization. Guan Zhenpeng et al. found that: advanced age, female, obesity, simultaneous bilateral joint surgery, the use of general anesthesia general anesthesia, the use of cemented artificial joint prosthesis as postoperative DVT risk factors, and female, obesity and the use of bone cement is more prominent, so for such patients, we need to pay more attention to the prevention of DVT in the postoperative period; Therefore, we recommend the use of anticoagulant drugs in the postoperative period for 4 weeks for patients who do not have major blood diseases. The review of lower extremity venous ultrasound or lower extremity venography before discharge reminds us that we should not slacken on the prevention of DVT, and urges us to seek better ways to prevent and control DVT and PE. We have been actively and adequately doing the perioperative measures to prevent DVT, such as actively treating chronic diseases before surgery; choosing small incision as much as possible to reduce tissue damage and shorten the operation time; instructing the patients to actively flex and extend the ankle joint and isometric contraction of quadriceps muscle after surgery, and starting limb pneumatic compression on the second day after surgery; giving the factor Ⅹ inhibitor in time and in appropriate amount after surgery; and letting the patients get out of the bed in early stage. Regarding the use of anticoagulants, unfortunately, there was still one patient who died within 3 days after surgery because of pulmonary embolism due to dislodged deep vein thrombus. This suggests that we should pay more attention to the prevention of DVT for artificial joint arthroplasty in patients with advanced age, and that preoperative and postoperative angiographic examinations are needed to exclude, and once DVT is detected, it should be dealt with in a timely and active manner, such as placing IVC filters. 4, Summary Rapid rehabilitation surgery as a rapidly developing treatment mode in recent years, its effectiveness and safety have been further confirmed. Due to the special characteristics of super-elderly hip fracture patients: many underlying diseases, poor reserve capacity, etc., multidisciplinary cooperation is more necessary for the treatment of patients, which reflects the advantages of rapid rehabilitation surgery. Through a series of rapid rehabilitation measures from admission to discharge, the risk of surgery and complications is reduced, and life expectancy is improved.