Purpose: To compare the mobility and health-related quality of life (HRQoL) for femoral neck fractures (FNFs) in the elderly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA).
Methods: This study constitutes a post hoc analysis of a prospective cohort study. In this secondary analysis, we enrolled patients aged ≥ 65 years who underwent arthroplasty for FNFs at a tertiary hospital in Beijing, China, between 2018 and 2019. Patients were stratified into the HA group and THA group based on the surgical type. All patients were followed up via telephone at 30, 120, and 365 days postoperatively. The Fracture Mobility Score (FMS) was utilized to assess patients' mobility, while the EuroQol 5-Dimension (EQ-5D) instrument was adopted to evaluate their HRQoL. Intergroup comparisons, multivariate logistic regression models, and linear regression models were used to compare outcomes between the two groups and analyze the impact of surgical type on these outcomes.
Results: Among 416 eligible patients, 333 completed all three follow-up evaluations, including 250 patients in the HA group and 83 in the THA group. Multivariate logistic regression models adjusted for potential confounders indicated that patients in the THA group were significantly more likely to achieve unrestricted mobility at 120 and 365 days postoperatively compared with the HA group (OR [95% CI] = 2.407 [1.210–4.788], p.adj = 0.012; OR [95% CI] = 2.410 [1.120–5.183], p.adj = 0.024), with no significant difference observed at the 30-day follow-up. In addition, multivariate linear regression models adjusted for 12 covariates demonstrated that the THA group achieved significantly higher EQ-5D scores at 30 and 120 days postoperatively (p.adj = 0.003 and p.adj = 0.003, respectively). However, this advantage was not sustained at the 365-day follow-up (p.adj = 0.100).
Conclusion: THA may yield a higher probability of independent mobility recovery and better postoperative HRQoL than HA in elderly patients with FNFs.
| [1] |
L. A. Cummings-Vaughn and J. K. Gammack, “Falls, Osteoporosis, and Hip Fractures,” Medical Clinics of North America 95, no. 3 (2011): 495–506.
|
| [2] |
J. A. Cauley, D. Chalhoub, A. M. Kassem, and G. E. Fuleihan, “Geographic and Ethnic Disparities in Osteoporotic Fractures,” Nature Reviews Endocrinology 10, no. 6 (2014): 338–351.
|
| [3] |
K. G. Thorngren, A. Hommel, P. O. Norrman, J. Thorngren, and H. Wingstrand, “Epidemiology of Femoral Neck Fractures,” Injury 33, no. 3 (2002): C1–C7.
|
| [4] |
S. C. Jonas, R. Shah, N. Al-Hadithy, M. R. Norton, S. A. Sexton, and R. G. Middleton, “Displaced Intracapsular Neck of Femur Fractures in the Elderly: Bipolar Hemiarthroplasty May Be the Treatment of Choice; a Case Control Study,” Injury 46, no. 10 (2015): 1988–1991.
|
| [5] |
K. S. Park, C. S. Oh, and T. R. Yoon, “Comparison of Minimally Invasive Total Hip Arthroplasty Versus Conventional Hemiarthroplasty for Displaced Femoral Neck Fractures in Active Elderly Patients,” Chonnam Medical Journal 49, no. 2 (2013): 81–86.
|
| [6] |
F. Migliorini, A. Trivellas, A. Driessen, et al., “Hemiarthroplasty Versus Total Arthroplasty for Displaced Femoral Neck Fractures in the Elderly: Meta-Analysis of Randomized Clinical Trials,” Archives of Orthopaedic and Trauma Surgery 140, no. 11 (2020): 1695–1704.
|
| [7] |
K. Liu, J. Sheng, H. Zhang, et al., “Risk Factors for Mortality After Uncemented Bipolar Hemiarthroplasty for Geriatric Displaced Femoral Neck Fracture,” Orthopedics 44, no. 4 (2021): e570–e576.
|
| [8] |
J. W. Huh, H. E. Seo, D. H. Lee, and J. H. Yoo, “Risk Factors of the 2-Year Mortality After Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture,” Hip Pelvis 35, no. 3 (2023): 164–174.
|
| [9] |
S. Baghdadi, M. Kiyani, S. H. Kalantar, et al., “Mortality Following Proximal Femoral Fractures in Elderly Patients: A Large Retrospective Cohort Study of Incidence and Risk Factors,” BMC Musculoskeletal Disorders 24, no. 1 (2023): 693.
|
| [10] |
A. El Motassime, E. Pesare, A. Russo, et al., “The Impact of Frailty and Gender Differences on Hospitalization and Complications in Proximal Femoral Pathological Fractures: A Cross-Sectional Study,” Journal of Personalized Medicine 14, no. 9 (2024): 991.
|
| [11] |
M. Salvini, G. Malerba, C. Meschini, et al., “Proximal Femur Replacement in Oncologic Lesion: Hemiarthroplasty vs Total Hip Arthroplasty-a Multicentric Retrospective Study,” Journal of Orthopaedic Surgery and Research 20, no. 1 (2025): 515.
|
| [12] |
J. Zhang, M. Yang, X. Zhang, et al., “The Effectiveness of a Co-Management Care Model on Older Hip Fracture Patients in China—A Multicentre Non-Randomised Controlled Study,” Lancet Regional Health—Western Pacific 19 (2021): 100348.
|
| [13] |
R. Katzman, M. Y. Zhang, O. Ya-Qu, et al., “A Chinese Version of the Mini-Mental State Examination; Impact of Illiteracy in a Shanghai Dementia Survey,” Journal of Clinical Epidemiology 41, no. 10 (1988): 971–978.
|
| [14] |
S. C. Voeten, W. S. Nijmeijer, M. Vermeer, I. B. Schipper, J. H. Hegeman, and DHFA Taskforce study group, “Validation of the Fracture Mobility Score Against the Parker Mobility Score in Hip Fracture Patients,” Injury 51, no. 2 (2020): 395–399.
|
| [15] |
M. Herdman, C. Gudex, A. Lloyd, et al., “Development and Preliminary Testing of the New Five-Level Version of EQ-5D (EQ-5D-5L),” Quality of Life Research 20, no. 10 (2011): 1727–1736.
|
| [16] |
K. Rand-Hendriksen, J. M. Ramos-Goñi, L. A. Augestad, and N. Luo, “Less Is More: Cross-Validation Testing of Simplified Nonlinear Regression Model Specifications for EQ-5D-5L Health State Values,” Value in Health 20, no. 7 (2017): 945–952.
|
| [17] |
M. Nayeemuddin, G. A. Higgins, E. Bache, J. O'hara, and P. Glitheroe, “Complication Rate After Operative Treatment of Paediatric Femoral Neck Fractures,” Journal of Pediatric Orthopaedics. Part B 18, no. 6 (2009): 314–319.
|
| [18] |
M. Barceló, O. H. Torres, J. Mascaró, and J. Casademont, “Hip Fracture and Mortality: Study of Specific Causes of Death and Risk Factors,” Archives of Osteoporosis 16, no. 1 (2021): 15.
|
| [19] |
C. C. Hong, N. Nashi, M. C. Makandura, and L. Krishna, “Cemented Hemiarthroplasty in Traumatic Displaced Femoral Neck Fractures and Deep Vein Thrombosis: Is There Really a Link?,” Singapore Medical Journal 57, no. 2 (2016): 69–72.
|
| [20] |
Y. T. Kim, J. H. Yoo, M. K. Kim, S. Kim, and J. Hwang, “Dual Mobility Hip Arthroplasty Provides Better Outcomes Compared to Hemiarthroplasty for Displaced Femoral Neck Fractures: A Retrospective Comparative Clinical Study,” International Orthopaedics 42, no. 6 (2018): 1241–1246.
|
| [21] |
F. C. Barışhan, B. Akesen, T. Atıcı, K. Durak, and M. S. Bilgen, “Comparison of Hemiarthroplasty and Total Hip Arthroplasty in Elderly Patients With Displaced Femoral Neck Fractures,” Journal of International Medical Research 46, no. 7 (2018): 2717–2730.
|
| [22] |
S. M. Dyer, M. Crotty, N. Fairhall, et al., “A Critical Review of the Long-Term Disability Outcomes Following Hip Fracture,” BMC Geriatrics 16, no. 1 (2016): 158.
|
| [23] |
K. Xiao, S. Liu, B. Liang, S. Li, X. Liu, and J. Chen, “Clinical Efficacy of THA With Dual Mobility Cup vs. Hemiarthroplasty in Elderly Patients With Femoral Neck Fracture: A Retrospective Study,” Frontiers in Surgery 12 (2025): 1507068.
|
| [24] |
C. J. Hedbeck, A. Enocson, G. Lapidus, et al., “Comparison of Bipolar Hemiarthroplasty With Total Hip Arthroplasty for Displaced Femoral Neck Fractures: A Concise Four-Year Follow-Up of a Randomized Trial,” Journal of Bone and Joint Surgery. American Volume 93, no. 5 (2011): 445–450.
|
| [25] |
B. Pass, L. Nowak, D. Eschbach, et al., “Differences of Hemiarthroplasty and Total Hip Replacement in Orthogeriatric Treated Elderly Patients: A Retrospective Analysis of the Registry for Geriatric Trauma DGU®,” European Journal of Trauma and Emergency Surgery 48, no. 3 (2022): 1841–1850.
|
| [26] |
B. Van Hout, M. F. Janssen, Y. S. Feng, et al., “Interim Scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L Value Sets,” Value in Health 15, no. 5 (2012): 708–715.
|
| [27] |
P. Campenfeldt, W. Ekström, A. N. Al-Ani, E. Weibust, K. Greve, and M. Hedström, “Health Related Quality of Life and Mortality 10 Years After a Femoral Neck Fracture in Patients Younger Than 70 Years,” Injury 51, no. 10 (2020): 2283–2288.
|
| [28] |
N. Parsons, X. L. Griffin, J. Achten, and M. L. Costa, “Outcome Assessment After Hip Fracture: Is EQ-5D the Answer?,” Bone and Joint Research 3, no. 3 (2014): 69–75.
|
| [29] |
J. E. Gjertsen, V. Baste, J. M. Fevang, O. Furnes, and L. B. Engesæter, “Quality of Life Following Hip Fractures: Results From the Norwegian Hip Fracture Register,” BMC Musculoskeletal Disorders 17 (2016): 265.
|
| [30] |
Y. Su, R. Li, X. Ren, et al., “The Health-Related Quality of Life for Hemiarthroplasty and Total Hip Arthroplasty in the Elderly: A Meta-Analysis,” Frontiers in Medicine (Lausanne) 10 (2023): 1022584.
|
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