Total hip arthroplasty results in better functional outcomes compared to hip hemiarthroplasty for displaced femoral neck fractures

The optimal surgical approach for displaced femoral neck fractures (FNF) in elderly patients remains debated. This study compares functional and clinical outcomes between total hip arthroplasty (THA) and hip hemiarthroplasty (HHA) performed by a single surgeon using a standardized anterior approach. A retrospective single-center analysis included 92 patients (45 HHA, 47 THA) aged ≥ 60 years treated between 2018 and 2020 with ≥ 1-year follow-up. Baseline demographics, operative characteristics, complications, and functional outcomes (Harris Hip Score, HHS) were compared using t-tests, chi-square tests, and multivariable linear regression. 92 patients were included with 45 in the HHA group and 47 in the THA group. Patients in the HHA group were older (85.4 ± 7.9 vs. 76.5 ± 9.0 years, p < 0.001), had higher ASA scores (2.5 ± 0.6 vs. 1.9 ± 0.6, p < 0.001), and longer time between admission and surgery (2.7 ± 3.3 vs. 1.3 ± 1.1 days, p = 0.004). In addition, despite the shorter operative time (53.0 ± 17.8 vs. 66.1 ± 21.0 min, p = 0.004), HHA patients had a higher rate of death (40% vs. 11%, p = 0.001). Patients in the HHA group also reported lower HHS (73.1 ± 19.8 vs. 91.4 ± 12.1, p < 0.001), with similar results reported in the multivariable regression model (R2 = 0.25). THA provides significantly better functional outcomes and lower mortality than HHA in elderly patients with displaced FNF, even after adjusting for confounders. These results highlight the importance of patient physiological optimization and procedure selection based on overall health rather than age alone.