Title: Comparative Outcomes of Total Hip Arthroplasty and Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures: A Retrospective Analysis

Abstract Femoral neck fractures, particularly prevalent among the elderly, demand timely and appropriate treatment due to high costs and the potential for severe complications. Selecting the correct treatment method is essential to prevent long-term issues such as dislocation and the need for reoperation. This study compares the outcomes of total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA) in treating femoral neck fractures. This retrospective, applied, observational, and descriptive-analytical study was conducted on 48 patients (24 in the THA group and 24 in the BHA group). Patient information was obtained from the surgical archives of Shariati Hospital in 2020–2021. During a telephone call, patients were asked questions from the Oxford Hip Scoring Questionnaire. Data were analyzed using the chi-square test, and significance was tested. Results are presented quantitatively. Results showed that patients who underwent total hip arthroplasty scored an average of 7.5 points higher than those who had bipolar hemiarthroplasty, a statistically significant difference (p < 0.05). This suggests that total arthroplasty may offer better overall performance and outcomes in terms of pain reduction and joint efficiency for patients over 50 years old. The superiority of total arthroplasty was observed across all age groups, with the most pronounced difference in the 60–69 age range (14.43 points), followed by the 50–59 age group (2.15 points), and the smallest difference in patients 70 years and older (1.38 points). These findings indicate that total hip arthroplasty may be particularly beneficial for patients between 50 and 69 years old, while the advantage becomes less pronounced in patients 70 years and older. Individual patient factors, including comorbidities and activity levels, should guide the choice between THA and BHA. Further research with larger sample sizes and extended follow-up periods is necessary to confirm these results and inform optimal clinical decision-making for treating femoral neck fractures.