Comparison Of The Clinical Efficacy After Total Hip Arthroplasty In Female Patients With Old And Fresh Femoral Neck Fractures

Objective:To compare the clinical efficacy after total hip arthroplasty in female patients with old and fresh femoral neck fractures.Methods:Female patients(195 cases in total)who underwent total hip arthroplasty for femoral neck fracture in Subei People’s Hospital from January 2014 to December 2021 were selected as the study subjects.The study subjects were divided into the old femoral neck fracture group(fracture time ≥ 3 weeks,total 90 cases)and the fresh femoral neck fracture group(fracture time < 3 weeks,total 105 cases)according to whether the fracture occurred for more than 3 weeks or not.The hip function was assessed according to Harris score and VAS score(Visual Analogue Scale);The imaging and complication indicators such as prosthetic dislocation,periprosthetic fracture,heterotopic ossification,periprosthetic osteolysis,stress shielding and stability of prosthetic fixation were reviewed by postoperative anteroposterior and lateral X-rays of the affected hip and anteroposterior X-rays of the pelvis in both groups;poor incision healing and periprosthetic infection were assessed by reviewing the laboratory results and observing the wound.Statistical analysis was performed using SPSS 27.0.Results:A total of 195 patients were included who were eligible for clinical follow-up,including90 patients in the old femoral neck fracture group and 105 patients in the fresh femoral neck fracture group.old femoral neck fracture group: follow-up time from 12 to 105 months,follow-up time 45.36±27.31 months on average;age from 45 to 86 years old,70.40±7.54 years old on average.Fresh femoral neck fracture group: follow-up time from 12 to 106 months,follow-up time 43.74±26.25 months on average;age from 49-85 years old,68.87±5.51 years old on average.On baseline information: there was no statistically significant difference between the old femoral neck fracture group and the fresh femoral neck fracture group in terms of BMI,age,height,weight,surgical side,comorbid diseases,anesthesia method,and ASA classification(P > 0.05).On perioperative indicators: there was no statistically significant difference between the old femoral neck fracture group and the fresh femoral neck fracture group in terms of total hospital stay,hospitalization cost,whether to drain postoperatively,and whether to transfer to ICU postoperatively(P > 0.05).The differences between the old and fresh femoral neck groups in the duration of surgery(76.78±34.33 min vs 67.74±18.38 min),hemoglobin loss before and after surgery difference(24.31±15.23 g/L vs 16.50±10.92g/L),intraoperative blood loss(240.78±235.78 m L vs 159.14±56.91 m L),postoperative blood transfusion volume was [0(600)m L vs 0(0)m L],hidden blood loss [595.73(855.17)m L vs 305.4(401.68)],total perioperative blood loss [823.09(873.76)m L vs473.38(455.61)m L],and postoperative blood transfusion rate(38.89% vs 10.48%)were statistically significant(P < 0.05).In terms of efficacy indexes: the preoperative Harris score(37.06±6.32 versus26.16±4.32)and preoperative VAS score were(4.22±1.19 versus 7.07±0.58)in the old femoral neck fracture group versus the new femoral neck fracture group,and the difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference between the two groups in the Harris score at 1 month after surgery,3 months after surgery,6 months after surgery,1 year after surgery,and at the final follow-up and in the VAS score at 1 month after surgery,3 months after surgery,6 months after surgery,1 year after surgery,and at the final follow-up(P >0.05).On the imaging results: no aseptic loosening of the prosthesis occurred in the two groups and the stability of prosthetic fixation in both groups was bone growing-in stable.There was no statistically significant difference between the two groups in stress shielding(3 cases vs 2 cases),heterotopic ossification(2 cases vs 1 case),and periprosthetic osteolysis(3 cases vs 2 cases)(P > 0.05).On the complications: there was no statistically significant difference between the old group and the fresh group in periprosthetic fracture(1 case vs 2 cases),prosthetic dislocation(3 cases vs 7 cases),poor incision healing(2 cases vs 3 cases),periprosthetic infection(1 case vs 0 cases),and bilateral lower limb discrepancy(4 cases vs 2 cases)(P > 0.05).Conclusions:1.For female patients,total hip arthroplasty can achieve good results for both fresh and old femoral neck fractures.2.Compared with the old femoral neck fracture group,the fresh group had shorter operative time,less hemoglobin loss before and after surgery,less intraoperative blood loss,less total perioperative blood loss,less hidden blood loss,fewer postoperative transfusions cases,and fewer postoperative transfusions volume.3.For female patients with initially diagnosed femoral neck fractures,early surgical intervention is recommended for female patients with no contraindications.