Background Femoral neck fractures (FNF) are common in elderly patients, and the management of Garden I classified fracture remains controversial. Non-operative treatment (NOT) has shown interesting results in selected patients, compared to primary arthroplasty (PA). But its failure leads to secondary displacement and requires delayed arthroplasty (DA). The aim of this study was to compare DA after failure of NOT and PA in patients over 65 years of age presenting with a Garden I FNF. Materials and Methods A retrospective analysis from a single-center prospectively collected database was conducted. Between January 2017 and January 2023, sixty-one patients presenting NOT failure of Garden I FNF and DA were identified. These cases were 1:1 matched based on age, sex, ASA score, BMI and Parker score before fracture to those with a PA. Primary outcome was patient survival rate at two years follow up. Functional outcome was evaluated using the Harris Hip Score (HHS) and Parker score at three months, one and two years. Perioperative complications and length of stay (LOS) were recorded. Results The two-year patient survival rate was 77.1% (47 patients) in the DA group and 85.2% (52 patients) in the PA group (p=0.401). There was no difference in HSS at the last follow up with 82.08 (SD 8.2) and 84.51 (SD 5.4) respectively (p=0.081). One complication (one dislocation) was observed in DA group and four in PA group (two dislocations and two infections) (p=0.199). One dislocation in PA group required an implant revision. There were no significant difference regarding blood loss, length of stay, or operating time. Conclusion DA after failure of NOT in Garden I FNF provides similar results to PA in terms of patient survival and functional outcomes. These data support the interest of NOT in selected elderly patients, with rigorous clinical and radiological follow-up.
Argenson et al. (Thu,) studied this question.