Clinical Effect of Total Hip Arthroplasty and Hemiarthroplasty under Direct Anterior Approach Pathway in the Treatment of Elderly Femoral Neck Fracture

LI Xuxiang; LIN Rongcai; WEI Peiran; XU Yan; WANG Liming; TANG Cheng

doi:10.14033/j.cnki.cfmr.2024.32.001

Abstract：Objective:To investigate the application effect of total hip arthroplasty(THA)and hemiarthroplasty(HA)under direct anterior approach(DAA)pathway in the treatment of elderly femoral neck fracture(FNF).Method:A total of 70 patients with FNF who admitted to the Department of Orthopedics,Nanjing First Hospital,Nanjing Medical University from January 2020 to January 2023 were selected as the research objects,the patients were divided into the treatment group 1(HA)and the treatment group 2(THA)based on the random number table method,with 35 cases in each group.The perioperative indexes,muscle tissue injury,bone metabolism and long-term hip function were compared between two groups.Result:The operation time of the treatment group 2 was longer than that of the treatment group 1,and the intraoperative blood loss and postoperative drainage volume were more than those of the treatment group 1,the differences were statistically significant(P＜0.05);however,there were no significant differences in the time of first ambulation,the incidence of postoperative complications,the rate of central fixation of femoral prosthesis and the time of postoperative hospitalization between two groups(P＞0.05).At 3 d after operation,the creatine kinase(CK)and C-reactive protein(CRP)in two groups were higher than those before operation,and those in the treatment group 2 were higher than those in the treatment group 1,the differences were statistically significant(P＜0.05);at 3 months after operation,the N-terminal propeptide of type Ⅰ precollagen(PⅠNP)and C-terminal telopeptides of type Ⅰ collagen(CTX)in two groups were lower than those before operation,and the bone-specific alkaline phosphatase(BAP)were higher than those before operation,the difference was statistically significant(P＜0.05);however,there were no significant differences in the PⅠNP,CTX and BALP between two groups at 3 months after operation(P＞0.05).At 5 months,8 months and 12 months after operation,the Harris scores of two groups were higher than those at 3 months after operation,and those in the treatment group 2 were higher than those in the treatment group 1,the differences were statistically significant(P＜0.05).Conclusion:Both THA and HA under DAA pathway have good therapeutic effects,and HA has advantages in perioperative indicators,and it is suitable for patients with poor physical conditions;THA has more advantages in recovery of long-term hip function,and it is suitable for patients with high mobility needs.