Superior functional outcome after femoral neck fracture for patients treated with total hip arthroplasty compared with internal fixation: a study of 132 patients

Background and Purpose: Internal fixation (IF) and total hip arthroplasty (THA) are both used as treatments for femoral neck fracture (FNF). The decision on the surgical method is made on an individual level, depending on the patient’s functional demands, fracture type, and the amount of fracture displacement. The goal of this study was to evaluate whether THA provides a better functional outcome compared with IF when evaluated by the Oxford Hip Score (OHS). Patients and Methods: A total of 132 FNF patients were included. Ninety-six (73%) patients underwent THA, and 36 (27%) underwent IF. The mean age was 68 (SD=9) years, and 86 (65%) were female. The results were analyzed using a linear mixed-effects model. Results: At 1 year, the mean difference in OHS scores between the patients treated with THA and those treated with IF was 7.5 points (95% CI: 3.6–11.4, P =0.0003). When the patients who underwent reoperation during the follow-up time were removed from the analysis, the difference decreased but was still statistically significant with a mean difference of 4.4 points (95% CI: 0.7–8.0, P =0.02). Five (14%) patients in the IF group and one (1%) patient in the THA group underwent reoperations. When the reoperated patients were removed from the sample, the difference was mitigated but still statistically significant with a mean difference of 4.35 points (95% CI: 0.65–8.05, P =0.02). Interpretation: The patients treated with THA had a better functional outcome compared with IF at the 1-year follow-up.