| Background and Objective:Femoral neck fracture is a major health problem afflicting the elderly.The mortality rate of elderly patients with femoral neck fracture within three months is as high as 13.5%.Comorbidities before fracture and complications after fracture make the treatment of femoral neck fracture in elderly patients difficult.Femoral neck fracture can be divided into undisplaced and displaced fractures.Among them,displaced femoral neck fracture has more serious injury,unstable fracture end,higher non-union rate and higher avascular necrosis rate of femoral head.Therefore,patients with displaced fracture should be treated by surgery if there is no operative contraindication.Hip arthroplasty is widely used in elderly patients with displaced femoral neck fracture.It is a routine treatment for displaced femoral neck fracture in the elderly.After operation,patients can move and undertake part of the weight bearing as soon as possible,which is conducive to preventing complications of fracture.Hip arthroplasty can be divided into hemiarthroplasty and total hip replacement.Hemiarthroplasty has the advantages of less intraoperative bleeding,shorter operation time and lower rate of prosthetic dislocation.However,acetabular erosion with different degrees of pain may affect the long-term hip function of patients.Total hip replacement can bring super-elderly better recovery of hip function and less pain,and can meet the requirements of independent life and activity of the super-elderly patients.However,more bleeding and longer operation time of total hip replacement and higher dislocation rate after total hip replacement counteract benefits mentioned before.At present,there is no unified view on the choice between them.The purpose of this study is to analyze the short-term hip function in super-elderly patients after hemiarthroplasty and total hip arthroplasty through follow-up data including modified Harris score of 1-year postoperatively,prosthesis dislocation rate,revision rate,and 1-year mortality,so as to provide scientific basis for the selection of appropriate surgical methods for super-elderly patients with displaced femoral neck fractureMethods:This study is a single-center retrospective study.From January 2015 to December 2018,patients with displaced femoral neck fracture underwent hip arthroplasty in the Nanjing Zhongda Hospital were divided into total hip arthroplasty group(THA)and hemiarthroplasty group(HA).The X-ray of hip and pelvis were collected at 1,2,3,6 and 12 months after operation,and the telephone follow-up data at 1-year after operation were collected,including the patients’ modified Harris score,revision operation and their survival status.The primary endpoint of the study was the modified Harris score(Including pain sub-score and function sub-score).The secondary end points were 1-year postoperatively prosthesis dislocation rate,revision rate,1-year mortality and costs of two surgical options.The quantitative data between the two groups were compared by t-test of independent samples and rank sum test.Chi square test was used to compare the heterotopia rate,revision rate and one-year mortality rate between the two groups.P<0.05 indicates that there is statistical difference.Results:A total of 208 patients were included in the study,94 in the HA group and 114 in the THA group;the average ages of the HA group and the THA group were 83.3±4.8 and 82.1±4.5 years old,respectively;Sex composition,age composition,fracture type,fracture location,ASA rating had no statistical difference(p>0.05).There was significant difference of average number of complications between groups(HA:2.91±0.55,THA:2.48±0.43,P=0.012).There was no significant difference of waiting time for surgery between the two groups(97.7±43.0 hours in HA vs.89.9±33.2 hours in THA,p=0.417).The mean operation time in the HA group was also significantly lower shorter than that in the THA group(89.3±30.5 min vs.116.8±33.7 min,p<0.000).The mean operation bleeding in the HA group was significantly lower than that in the THA group(132.2±51.7 ml vs.203.76±60.4 ml,p<0.000).The average length of stay was 18±3.1 days in the HA group and 14±2.7 days in the THA group(p<0.000);79.55%of the HA group and 81.25%of the THA group had no pain at one-year follow-up.The average pain score of the HA group was 42.8±3.6 and that of the THA group was 43.1±2.0 with no statistical difference(p=0.431),and none of patients bear marked pain(serious limitations)or totally disabled in both groups;The average modified Harris score in the HA group was 71.7±15.9,and that in the THA group was 81.1±11.7,with statistical difference(p<0.000);30 patients(34.09%)in the HA group and 73 patients(65.18%)in the THA group have attained Harris scores above 82(excellent),26 patients(29.55%)in the HA group and 9 patients(8.03%)in the THA group score below 61(poor).70.50%of the patients(141/200)had good functional outcomes after hip replacement(with modified Harris score above 72),while 17.50%(35/200)had poor outcomes(with modified Harris score below 60).There was no prosthesis dislocation and infections in the HA group and the THA group within one year after operation.No revision operation was performed in either group within 1 year.Six HA group patients(6.38%,three died of myocardial infarction,two from pulmonary embolism and one from cerebral infarction)died within one year after operation,which was significantly higher than that in the THA group(2cases,1.75%,all due to myocardial infarction).The average total cost in HA group was $8162±1052,while that in THA group was$9828±1192,with significant difference(p<0.000);the cost of treatment materials in HA group was $4459±1056,and that in THA group was $6738±1441,with significant difference(p<0.000).After excluding the cost of treatment materials,the treatment costs($3702±149)in HA group were slightly higher than that in THA group($3090 ± 206),with no significant difference(P=0.312)There was no significant difference between the two groups in the average cost of medicine and treatment per day.Conclusion:Artificial hip replacement provides good outcomes for elderly patients with displaced femoral neck fracture.Most patients achieved satisfactory functional outcomes within one year after hemiarthroplasty or total hip replacement.The operation time of hemiarthroplasty is short and bleeding during the operation is less.Hemiarthroplasty is suitable for the elderly patients with poor basic conditions and low tolerance to surgery and anesthesia Patients had less pain within 1 year after hemiarthroplasty and total hip replacement and no patients bear marked pain or totally disabled.One year after operation,hip functions of patients receiving total hip replacement are better than those of hemiarthroplasty.Most of the patients obtained excellent hip function after total hip replacement.In the short term,total hip replacement provided patients better hip function,better self-care ability and higher independence than hemiarthroplasty.One year after the operation,the patients received hemiarthroplasty or total hip replacement didn’t experience prosthesis dislocation and revision surgery.The average total treatment cost and other treatment materials cost of hemiarthroplasty were lower than those cost of total hip replacement,but there was no significant difference between the daily average drug cost and the daily average treatment cost.Although the total treatment cost of hemiarthroplasty is less than that of total hip replacement,mainly due to the higher cost of prosthesis used in total hip replacement.Considering that the prosthesis used in total hip replacement has longer service life,the higher medical cost is not the reason to refuse total hip replacement.Total hip replacement provides excellent short-term hip function for the elderly with displaced femoral neck fracture.It is suitable for the elderly who have higher requirements for independent life quality and more activities. |
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