Mitsutake Ryo, Tanino Hiromasa, Sato Go, Ito Hiroshi
Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Department of Orthopaedic Surgery, Hokkaido Social Welfare Association Furano Hospital, Furano, Hokkaido, Japan.
PLoS One. 2025 May 8;20(5):e0323106. doi: 10.1371/journal.pone.0323106. eCollection 2025.
The treatment of displaced femoral neck fractures in patients aged 60-80 years old remains controversial. Arthroplasty has been reported to have lower complication rates than internal fixation (IF). However, less is known about the outcomes as perceived by the patient. The aim of the present study (the cross-sectional study) was to evaluate the patient-reported outcome measures (PROMs) of patients aged 60-80 years old with femoral neck fractures treated with IF or total hip arthroplasty (THA).
We investigated 92 patients affected by displaced femoral neck fractures who were treated between January 2015 and September 2022. Forty-eight patients were treated with IF, and 44 patients with THA. The outcomes were Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), visual analogue scale (VAS) for pain, and VAS for patient satisfaction at 12 months postoperatively. Complications and reoperations were continuously monitored.
The mean patient age was 68.1 ± 6.6 years. HHS, all dimensions of the HOOS and JHEQ scores, VAS for pain, and VAS for patient satisfaction at 12 months were significantly superior in the THA group compared to the IF group. All outcome measures were superior in the THA group, with mean differences exceeding their respective minimal clinically important differences or minimal detectable changes at 12 months. The rate of major reoperations was significantly higher in the IF group (14.5%) than the THA group (2.2%).
We found that patients aged 60-80 years old who underwent THA for displaced femoral neck fractures experienced better outcomes, including PROMs, than those who underwent IF. Furthermore, THA resulted in fewer reoperations than IF.
60 - 80岁患者移位型股骨颈骨折的治疗仍存在争议。据报道，关节置换术的并发症发生率低于内固定术（IF）。然而，患者对治疗结果的感受却鲜为人知。本研究（横断面研究）的目的是评估60 - 80岁股骨颈骨折患者接受IF或全髋关节置换术（THA）治疗后的患者报告结局指标（PROMs）。
我们调查了92例2015年1月至2022年9月间接受治疗的移位型股骨颈骨折患者。48例患者接受IF治疗，44例患者接受THA治疗。结局指标包括Harris髋关节评分（HHS）、髋关节功能与骨关节炎结局评分（HOOS）、日本骨科协会髋关节疾病评估问卷（JHEQ）、疼痛视觉模拟量表（VAS）以及术后12个月的患者满意度VAS。持续监测并发症和再次手术情况。
患者平均年龄为68.1±6.6岁。与IF组相比，THA组术后12个月时的HHS、HOOS各维度及JHEQ评分、疼痛VAS和患者满意度VAS均显著更高。THA组所有结局指标均更优，12个月时的平均差异超过各自的最小临床重要差异或最小可检测变化。IF组的再次大手术率（14.5%）显著高于THA组（2.2%）。
我们发现，60 - 80岁移位型股骨颈骨折患者接受THA治疗后的结局，包括PROMs，优于接受IF治疗的患者。此外，THA导致的再次手术比IF少。
