Arthroplasty for femoral neck fracture of the elderly: a narrative review

This review provides an up-to-date, focused, and evidence-based treatment strategy addressing the ongoing debates in the literature surrounding arthroplasty for displaced femoral neck fractures in the elderly. Every effort should be made to perform surgery within 24-36 h of admission. After-hours surgery may be performed safely when an experienced team and adequate resources are available; if not, postponing to daytime hours to optimize surgical conditions is reasonable. While pre-fracture mobility, independence, and comorbidity are relevant in treatment planning, current high-level evidence does not support a consistent clinical benefit of total hip arthroplasty over hemiarthroplasty, even in selected, higher-functioning patients. Given the substantially increased risk of periprosthetic fracture associated with cementless fixation, cemented stems should be preferred in elderly patients with displaced femoral neck fractures.