Early versus delayed hip arthroplasty for femoral neck fractures in the elderly: a comparative study on
Feifan He1, Feng Yang2, Juan Wang3
1Department of Joint Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Background:
The incidence of femoral neck fractures in the elderly is increasing due to global population aging, posing a significant public health challenge. The optimal timing for surgical intervention remains controversial. To determine if early surgical intervention reduces complications and enhances therapeutic efficacy in elderly patients with femoral neck fractures undergoing hip arthroplasty.
Objective:
To compare the effects of surgery performed ≤48 h (early) versus >48 h (late) after injury on 30-day complications and 1-year integrated somatic-psychosocial recovery.
Methods:
A retrospective cohort study enrolled 168 consecutive patients aged ≥65 years with Garden-IV femoral neck fracture who underwent hip arthroplasty between January 2023 and December 2024. 77 patients were operated on within 48 h and 91 after 48 h. The primary endpoint was the 30-day composite complication rate; secondary endpoints included length of stay (LOS), haemoglobin drop, inflammatory biomarkers, Harris Hip Score (HHS), Forgotten Joint Score (FJS), 15-item Geriatric Depression Scale (GDS-15) and Lawton Instrumental Activities of Daily Living (IADL) scale.
Results:
Early surgery reduced the 30-day composite complication rate to 29.9% versus 60.4% in the late group (χ2 = 15.670, p < 0.001, ARR = 30.5, 95%CI:(16.2 to 44.9%)), driven by lower incidences of hypoalbuminaemia (3.9% vs. 24.2%, χ2 = 13.542, p < 0.001, ARR = 20.3, 95%CI:(10.5 to 30.1%)) and joint pain (1.3% vs. 11.0%, χ2 = 6.401, p = 0.012, ARR = 9.7, 95%CI:(2.8 to 16.6%)). LOS was shortened by 4.6 days (t = -9.969, p < 0.001) and post-operative haemoglobin decline (115.43 ± 15.03 vs. 98.04 ± 18.48 g/L, t = 6.609, p < 0.001). At 1 month, the early group achieved 10.9 points higher HHS (79.12 ± 4.37 vs. 68.24 ± 8.06, t = 11.090, p < 0.001) and 13.3 points higher FJS (68.74 ± 7.10 vs. 55.46 ± 9.56, t = 10.308, p < 0.001); the advantage persisted at 3 months but disappeared at 6 months. GDS-15 scores were 2.2, 2.7 and 2.0 points lower at 1, 3 and 6 months (1 month: 5.40 ± 3.77 vs. 7.62 ± 2.49, t = -4.546, p < 0.001; 3 months: 2.99 ± 2.57 vs. 5.64 ± 1.74, t = -7.682, p < 0.001; 6 months: 1.95 ± 1.44 vs. 3.97 ± 2.21, t = -7.114, p < 0.001). Lawton-Brody IADL Scores (1 month: 26.29 ± 11.39 vs. 34.37 ± 3.75, t = -5.962, p < 0.001; 3 months: 23.27 ± 9.86 vs. 32.47 ± 4.17, t = -7.630, p < 0.001; 6 months: 20.84 ± 6.37 vs. 29.27 ± 8.06, t = -77.571, p < 0.001). No differences were observed in intra-operative blood loss, operative time, 90-day readmission or 1-year mortality.
Conclusion:
Hip arthroplasty performed within 48 h after femoral neck fracture in the elderly significantly decreases early complications, shortens hospitalisation, accelerates functional recovery and sustains better mood and daily activity without increasing intra-operative risk or late mortality.
