Comparison of Functional Outcomes of Cemented Bipolar Hemiarthroplasty Versus Uncemented Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Patients Over 60 Years: A Prospective Randomized Study

Background Displaced femoral neck fractures in elderly patients pose significant challenges due to osteoporosis and comorbidities. Apart from Internal Fixation, which is reserved for non-osteoporotic young patients, bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) are common surgical options, but optimal management remains debated. Objective To compare the functional outcomes, surgical parameters, and complications of cemented BHA versus uncemented THA in patients over 60 years with displaced femoral neck fractures. Methods In this prospective randomized study, 40 patients (mean age, 66.7 years) with displaced femoral neck fractures were allocated to either uncemented THA (group 1, n=20) or cemented BHA (group 2, n=20). Outcomes were assessed using the Harris Hip Score (HHS) at 14 days, one, three, six, and 12 months postoperatively. Secondary outcomes included surgical duration, blood loss, weight-bearing initiation, and complications. Results THA demonstrated significantly higher HHS at 14 days (21.40 vs 20.05, p=0.03) and three months (64.55 vs 59.60, p=0.001), but no significant differences were noted at six and 12 months. BHA was associated with shorter surgical duration (75.0 vs 96.25 minutes, p<0.001) and less blood loss (307.65 vs 357.50 mL, p<0.001). No significant differences were found in weight-bearing initiation or complication rates, including infection, dislocation, or reoperation. Conclusion Both THA and BHA yield comparable long-term functional outcomes in elderly patients with displaced femoral neck fractures. THA offers superior early functional recovery, while BHA is advantageous for shorter surgical time and reduced blood loss. Treatment should be individualized based on patient factors and surgical expertise.