What Are the Differences between Multiple Screw Fixation and Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture?: A Twenty-Year Study from Tertiary Referral Hospital

Purpose: Hip fracture surgery is a high-stakes topic due to elevated mortality and high economic costs, making the identification of optimal treatment for displaced femoral neck fracture (FNF) pivotal. Our study aimed to evaluate and compare (1) surgery-associated parameters and (2) mortality rates following multiple screw fixation (MSF) or cementless bipolar hemiarthroplasty (BHA) in patients with displaced FNF using twenty years of data from a single tertiary referral center. Materials and Methods: Between January 2000 and January 2018, we analyzed 1,153 cases of displaced FNFs treated at our institution with either MSF or cementless BHA. We evaluated (1) surgery-associated parameters, (2) hospitalization duration, and (3) postoperative complications and mortality rates at one and five years following the surgical procedure. Results: MSF showed a reduced waiting period preceding surgery, a shortened duration of the surgical procedure, but an extended period of hospitalization. There was an increase of estimated blood loss and postoperative transfusion with cementless BHA compared to that with MSF. Both the procedures did not differ in postoperative complications. The one-year and five-year mortality rates were also similar in both groups. Conclusion: Since cementless BHA and MSF surgeries did not distinctly differ in mortality rates at one year and at five years, it is crucial that surgeons make personalized surgical decisions based on the individual characteristics of the patient. Surgeons should carefully weigh the advantages of MSF, which include shortened surgery time and low blood loss against the benefits (e.g., reduced hospitalization period) of cementless BHA.