Comparison of Outcomes Between Total Hip Arthroplasty and Hemiarthroplasty for Osteoporotic Femoral Neck Fractures, Along with Factors Affecting Postoperative Hip Joint Functional Recovery.

BACKGROUND Osteoporotic femoral neck fractures cause substantial disability in older adults. Although joint replacement is the standard treatment, the choice between total hip arthroplasty (THA) and hemiarthroplasty (HA) remains controversial. This study compared outcomes of THA and HA and identified factors influencing postoperative hip functional recovery. MATERIAL AND METHODS This retrospective study included 98 patients, with 52 in the THA group and 46 in the HA group. Surgical parameters and outcomes were compared, including hip function assessed by the Harris Hip Score (HHS), pain evaluated using the visual analog scale (VAS), and physical performance measured by the Short Physical Performance Battery (SPPB) at 3, 6, and 12 months postoperatively. Postoperative complications were recorded. Good functional recovery was defined as HHS ≥80 at 1 year. Univariate and multivariate logistic regression analyses were performed to identify factors associated with functional recovery. RESULTS The THA group had significantly longer operative time, greater intraoperative blood loss, and higher postoperative drainage volume than the HA group (P<0.01). At 6 and 12 months, THA patients showed significantly better hip function, physical performance, and lower activity-related VAS scores (P<0.05). Overall complication rates were similar (P>0.05); however, acetabular wear-related pain occurred in 4 patients only in the HA group. Multivariate analysis showed that younger age, higher bone mineral density T-score, THA, and good rehabilitation compliance independently predicted favorable functional recovery (P<0.05). CONCLUSIONS THA provides superior medium- to long-term functional outcomes compared with HA. Surgical decisions should consider age, bone quality, functional demands, and rehabilitation compliance, prioritizing THA when appropriate.