Impact of timing selection for THA on outcomes in elderly patients with femoral neck fracture

doi:10.3877/cma.j.issn.2096-0263.2026.03.005

Abstract

Abstract:

Objective

To explore the impact of timing selection for total hip arthroplasty (THA) on postoperative outcomes in the elderly with femoral neck fracture (FNF).

Methods

A total of 158 elderly patients with FNF admitted from August 2021 to August 2024 were selected as the research subjects. According to the different timing of THA, the patients were divided into the study group (undergoing THA within 48 h after fracture, n=79) and the control group (undergoing THA after 48 h of fracture, n=79). To further balance the potential differences between the two groups, propensity score matching (PSM) was used to match the baseline data at a ratio of 1:1. Perioperative data and hip joint function [Harris hip score (HHS), Functional recovery scale (FRS) for hip fracture, Visual analogue scale (VAS) for pain] of the matched patients were compared and analyzed. Cox proportional hazards model was used to analyze the impact of timing selection on complication events.

Results

After PSM, 59 patients were matched in both the study group and the control group, with comparable baseline data (P>0.05). Compared with the control group, the study group had significantly shorter operation time and post-operative hospital stay (P<0.05), as well as significantly less intra-operative blood loss and a lower incidence of complications (P<0.05). HHS score and FRS score of both groups were significantly higher than those before surgery (P<0.05), while VAS scores were significantly lower than those before surgery (P<0.05), and these changes were more pronounced in the study group (P<0.05). Cox proportional hazards model analysis indicated that after adjusting for covariates, performing THA within 48 hours of admission remained an independent protective factor for reducing the incidence of post-operative complications in patients with FNF (HR=0.217, 95% CI: 0.060, 0.784, P=0.020).

Conclusion

For elderly patients with FNF who meet the surgical indications and have no clear contraindications, undergoing THA within 48 hours of fracture results in more significant improvement in hip function scores and pain relief, and a reduction in postoperative complications. This study recommends prioritizing this treatment regimen.

Key words: Femoral neck fracture, Total hip arthroplasty, Surgical timing selection, Hip joint function, Aged

Jiamu Zhang, Wanyin Wang, Luoliang Zhou, Yangfan Chen, Wenhua Cai, Liang Guo. Impact of timing selection for THA on outcomes in elderly patients with femoral neck fracture[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2026, 12(03): 159-165.

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Figures/Tables 5

References 27

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指标	PSM前				PSM后
指标	研究组（n=79）	对照组（n=79）	χ²/t值	P值	研究组（n=59）	对照组（n=59）	χ²/t值	P值
年龄（岁，±s）	69.72±3.09	69.82±3.36	0.197	0.844	69.69±2.88	70.20±3.64	0.841	0.402
性别[例（%）]			0.408	0.523			0.311	0.577
男	45（56.96）	41（51.90）			35（59.32）	32（54.24）
女	34（43.04）	38（48.10）			24（40.68）	27（45.76）
体质量指数（kg/m², ±s）	24.92±2.66	24.60±2.56	0.753	0.452	24.89±2.68	24.77±2.66	0.235	0.815
患侧[例（%）]			0.228	0.633			0.000	1.000
左	37（46.84）	40（50.63）			29（49.15）	29（49.15）
右	42（53.16）	39（49.37）			30（50.85）	30（50.85）
Garden骨折分型[例（%）]			0.425	0.515			0.314	0.575
Ⅲ型	46（58.23）	50（63.29）			33（55.93）	36（61.02）
Ⅳ型	33（41.77）	29（36.71）			26（44.07）	23（38.98）
骨折原因[例（%）]			1.476	0.688			2.070	0.558
跌倒伤	49（62.03）	53（67.95）			36（61.02）	39（66.10）
坠落伤	11（13.92）	12（15.38）			7（11.86）	10（16.95）
交通事故	15（18.99）	11（14.10）			14（23.73）	9（15.25）
其他	4（5.06）	2（2.56）			2（3.39）	1（1.69）
高血压[例（%）]			0.845	0.358			0.100	0.752
有	9（11.39）	13（16.46）			5（8.47）	6（10.17）
无	70（88.61）	66（83.54）			54（91.53）	53（89.83）
糖尿病[例（%）]			1.769	0.184			0.076	0.782
有	9（11.39）	15（18.99）			8（13.56）	7（11.86）
无	70（88.61）	64（81.01）			51（86.44）	52（88.14）
冠心病[例（%）]			5.405	0.020			0.000	1.000
有	8（10.13）	19（24.05）			8（13.56）	8（13.56）
无	71（89.87）	60（75.95）			51（86.44）	51（86.44）

指标	PSM前				PSM后
指标	研究组（n=79）	对照组（n=79）	χ²/t值	P值	研究组（n=59）	对照组（n=59）	χ²/t值	P值
年龄（岁，±s）	69.72±3.09	69.82±3.36	0.197	0.844	69.69±2.88	70.20±3.64	0.841	0.402
性别[例（%）]			0.408	0.523			0.311	0.577
男	45（56.96）	41（51.90）			35（59.32）	32（54.24）
女	34（43.04）	38（48.10）			24（40.68）	27（45.76）
体质量指数（kg/m², ±s）	24.92±2.66	24.60±2.56	0.753	0.452	24.89±2.68	24.77±2.66	0.235	0.815
患侧[例（%）]			0.228	0.633			0.000	1.000
左	37（46.84）	40（50.63）			29（49.15）	29（49.15）
右	42（53.16）	39（49.37）			30（50.85）	30（50.85）
Garden骨折分型[例（%）]			0.425	0.515			0.314	0.575
Ⅲ型	46（58.23）	50（63.29）			33（55.93）	36（61.02）
Ⅳ型	33（41.77）	29（36.71）			26（44.07）	23（38.98）
骨折原因[例（%）]			1.476	0.688			2.070	0.558
跌倒伤	49（62.03）	53（67.95）			36（61.02）	39（66.10）
坠落伤	11（13.92）	12（15.38）			7（11.86）	10（16.95）
交通事故	15（18.99）	11（14.10）			14（23.73）	9（15.25）
其他	4（5.06）	2（2.56）			2（3.39）	1（1.69）
高血压[例（%）]			0.845	0.358			0.100	0.752
有	9（11.39）	13（16.46）			5（8.47）	6（10.17）
无	70（88.61）	66（83.54）			54（91.53）	53（89.83）
糖尿病[例（%）]			1.769	0.184			0.076	0.782
有	9（11.39）	15（18.99）			8（13.56）	7（11.86）
无	70（88.61）	64（81.01）			51（86.44）	52（88.14）
冠心病[例（%）]			5.405	0.020			0.000	1.000
有	8（10.13）	19（24.05）			8（13.56）	8（13.56）
无	71（89.87）	60（75.95）			51（86.44）	51（86.44）

围术期指标	研究组（n=59）	对照组（n=59）	t值	P值
手术时间（min）	113.80±12.61	119.98±13.26	2.597	0.011
术中出血量（mL）	341.60±14.01	352.28±14.62	4.052	<0.001
术后住院时间（d）	14.37±1.47	15.08±1.42	2.675	0.009

围术期指标	研究组（n=59）	对照组（n=59）	t值	P值
手术时间（min）	113.80±12.61	119.98±13.26	2.597	0.011
术中出血量（mL）	341.60±14.01	352.28±14.62	4.052	<0.001
术后住院时间（d）	14.37±1.47	15.08±1.42	2.675	0.009

指标	时间	研究组（n=59）	对照组（n=59）	t/U值	P值
HHS评分（分）	术前	42.44±5.18	41.78±5.24	0.688	0.493
	术后1个月	70.15±5.14^*	63.53±5.51^*	6.748	<0.001
	术后6个月	83.17±5.76^*#	76.53±6.36^*#	5.944	<0.001
	术后12个月	92.71±3.48^*#&	90.59±4.85^*#&	2.728	0.007
	F值	1142.427	833.877
	P值	<0.001	<0.001
FRS评分（分）	术前	42.39±4.77	42.66±5.62	0.281	0.779
	术后1个月	68.42±6.49^*	62.84±5.67^*	4.973	<0.001
	术后6个月	75.07±7.17^*#	69.29±7.00^*#	4.431	<0.001
	术后12个月	87.93±5.64^*#&	85.37±5.96^*#&	2.396	0.018
	F值	585.194	497.128
	P值	<0.001	<0.001
VAS评分（分）	术前	7.03±0.69	7.17±0.72	1.078	0.283
	术后1个月	5.03±1.26^*	5.78±1.15^*	3.377	<0.001
	术后6个月	2.75±0.51^*#	3.08±0.75^*#	2.795	0.006
	术后12个月	0（0，1）^*#&	0（0，1）^*#&	0.367	0.714
	K-W值	212.194	208.173
	P值	<0.001	<0.001

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