Functional Recovery After Total Hip Arthroplasty Versus Hemiarthroplasty in Elderly Patients with Femoral Neck Fractures: A Prospective Cohort Study

Background/Objectives: Displaced femoral neck fractures in older adults are associated with substantial morbidity, loss of functional independence, and reduced quality of life. Although total hip arthroplasty (THA) and hemiarthroplasty (HA) are widely used surgical options and have been extensively compared, differences in postoperative functional recovery in routine clinical practice continue to be investigated. This study aimed to compare postoperative functional outcomes between THA and HA in elderly patients with femoral neck fractures during postoperative follow-up. Methods: This prospective cohort study included 100 patients aged 70–85 years treated surgically for displaced femoral neck fractures from 1 May to 1 December 2024. Patients underwent THA (n = 57) or HA (n = 43). Functional recovery was evaluated using the Barthel Index (BI) and modified Harris Hip Score (mHHS) at 3 weeks, 3 months, and 6 months postoperatively. Changes in functional outcomes during follow-up were analyzed using repeated-measures general linear models adjusted for age, body mass index (BMI), and educational level. Exploratory binary postoperative outcomes were analyzed using logistic regression. Results: Patients treated with THA demonstrated significantly better postoperative functional outcomes compared with HA throughout follow-up. In both unadjusted and adjusted analyses, THA patients achieved consistently higher BI and mHHS scores across repeated postoperative assessments, including at 6 months postoperatively. Independent outdoor walking at 3 months postoperatively differed significantly between groups in the unadjusted analysis, although this association did not remain statistically significant after adjustment. In adjusted analyses, patients in the HA group demonstrated significantly higher odds of movement-related hip pain at 6 months postoperatively. Conclusions: THA was associated with significantly better postoperative functional outcomes compared with HA in elderly patients with femoral neck fractures. These findings highlight the importance of considering functional recovery outcomes, in addition to traditional surgical outcomes, when selecting arthroplasty strategies in geriatric hip fracture management. Given the observational study design, these findings should be interpreted as associations rather than evidence of a causal treatment effect.