ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Early versus Delayed Hip Arthroplasty for Femoral Neck Fractures in the Elderly: A Comparative Study on Multidimensional Recovery
Feifan He 1
Feng Yang 2,3
Yang Lu 1
Ganantes Ganati 1
Chong Gao 4,5
Jian Gao 1
1. The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
2. Nantong Rici Hospital, Nantong, China
3. Yangzhou University Medical College, Yangzhou, China
4. Second People's Hospital of Lianyungang, Lianyungang, China
5. Affiliated Hospital of Nantong University, Nantong, China
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Abstract
Objective: To compare the effects of surgery performed ≤48 h (early) versus >48 h (late) after injury on 30-day complications and 1-year integrated somatic-psychosocial recovery. Methods: A retrospective study enrolled 168 consecutive patients aged ≥65 years with femoral neck fracture who underwent hip arthroplasty between January 2023 and December 2024. 77 patients within 48 h and 91 after 48 h. The primary endpoint was the 30-day composite complication rate; secondary endpoints included length of stay (LOS), haemoglobin drop, inflammatory biomarkers, Harris Hip Score (HHS), Forgotten Joint Score (FJS), 15-item Geriatric Depression Scale (GDS-15) and Lawton Instrumental Activities of Daily Living (IADL) scale. Results: Early surgery reduced the 30-day composite complication rate to 29.9 % versus 60.4 % in the late group (χ2=15.670, p < 0.001,ARR=30.5%,95%CI:(16.2% to 44.9%)), driven by lower incidences of hypoalbuminaemia (3.9 % vs 24.2 %, χ2=13.542, p <0.001,ARR=20.3%,95%CI:(10.5% to 30.1%)) and joint pain (1.3 % vs 11.0 %, χ2=6.401, p = 0.012,ARR=9.7%,95%CI:(2.8% to 16.6%)). LOS was shortened by 4.6 days (t=-9.969, p < 0.001) and post-operative haemoglobin decline (115.43 ± 15.03 vs. 98.04 ± 18.48 g/L, p < 0.001). At 1 month, the early group achieved 10.9 points higher HHS (79.12 ± 4.37 vs. 68.24 ± 8.06, p < 0.001) and 13.3 points higher FJS (68.74 ± 7.10 vs. 55.46 ± 9.56, p < 0.001); the advantage persisted at 3 months but disappeared at 6 months. GDS-15 scores were 2.2, 2.7 and 2.0 points lower at 1, 3 and 6 months(1 month: 5.40 ± 3.77 vs. 7.62 ± 2.49, p < 0.001; 3 months: 2.99 ± 2.57 vs. 5.64 ± 1.74,p < 0.001; 6 months: 1.95 ± 1.44 vs. 3.97 ± 2.21, p < 0.001). IADL Scores (1 month: 26.29 ± 11.39 vs. 34.37 ± 3.75,p < 0.001;3 months: 23.27 ± 9.86 vs. 32.47 ± 4.17, p < 0.001;6 months: 20.84 ± 6.37 vs. 29.27 ± 8.06, p < 0.001). Conclusions: Hip arthroplasty performed within 48 h after femoral neck fracture in the elderly significantly decreases early complications, shortens hospitalisation, accelerates functional recovery and sustains better mood and daily activity without increasing intra-operative risk or late mortality.
Summary
Keywords
Femoral neck fracture, Forgotten joint score, GDS-15 scores, Harris score, hip arthroplasty, IADL scores, Perioperative Period, Timing of surgery
Received
23 September 2025
Accepted
26 January 2026
Copyright
© 2026 He, Yang, Lu, Ganati, Gao and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Chong Gao; Jian Gao
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