Minimally invasive total hip arthroplasty versus minimally invasive hemiarthroplasty for geriatric femoral neck fractures: efficacy and impact on inflammatory and stress markers.

Abstract

Objective: To compare the clinical efficacy, inflammatory responses, and surgical stress between minimally invasive total hip arthroplasty (MIS-THA) and minimally invasive hemiarthroplasty (MIS-HA) in the treatment of femoral neck fractures (FNFs) in elderly patients.

Methods: From December 2018 to December 2021, 98 elderly patients with FNFs were enrolled, with 50 undergoing MIS-THA (observation group) and 48 undergoing MIS-HA (reference group). The clinical efficacy, surgery-related parameters (including intraoperative blood loss, postoperative drainage volume, and operation time), postoperative recovery (hip joint recovery time and hospitalization), and complication rates were compared between the two groups. Interleukin-6 (IL-6), C-reactive protein (CRP), Harris Hip Score, and Visual Analog Scale (VAS) scores were assessed preoperatively and postoperatively. Cortisol (Cor) and malondialdehyde (MDA) levels were measured at four time points: preoperatively (T0), immediately postoperatively (T1), and at 24 hours (T2) and 72 hours (T3) post-surgery. Additionally, efficacy comparisons were conducted across different age groups and fracture types.

Results: The observation group demonstrated significantly higher treatment efficacy, shorter hip recovery time, and better functional outcomes (as evidenced by higher Harris and lower VAS scores) compared to the reference group. MIS-THA was associated with longer operative time, greater blood loss, and increased drainage volume (P<0.05), while hospitalization time and complication rates were comparable between groups (P>0.05). Postoperative IL-6 and CRP levels were elevated in both groups, but remained lower in the observation group (P<0.05). Stress markers (Cor and MDA) peaked at T2 and declined thereafter, with milder fluctuations observed in the observation group (P<0.05). The total effectiveness rate didn't differ significantly between the two groups across different age groups and fracture types.

Conclusion: MIS-THA provides superior efficacy, faster functional recovery, and more pronounced pain relief, along with a milder inflammatory and stress response, compared to MIS-HA in elderly patients with FNFs. Despite longer operation time, greater intraoperative blood loss, and higher postoperative drainage, MIS-THA and MIS-HA exhibit similar safety profiles, as evidenced by comparable hospitalization durations and complication rates.