Decision-making Between Arthroplasty and Osteosynthesis in Geriatric Hip Fragility Fractures: Insights into Clinical Outcomes

Aim Geriatric hip fragility fractures represent a significant challenge in orthopedic practice due to high morbidity and functional impairment. The choice between arthroplasty and osteosynthesis remains a critical decision influenced by patient factors, fracture characteristics, and expected outcomes. This study aimed to compare the clinical outcomes of arthroplasty and osteosynthesis in elderly patients with hip fragility fractures, identifying the most effective treatment approach. Methods A retrospective cohort study was conducted, including 130 patients treated at a tertiary center between 2016 and 2023. Patients were divided into two groups: 65 underwent arthroplasty (55 hemiarthroplasty, 10 total hip arthroplasty) and 65 osteosynthesis with proximal femoral nails. Intraoperative metrics (surgical duration, blood loss), postoperative parameters (mobilization time, hospital stay, complications), functional outcomes (Harris Hip Score [HHS], Visual Analog Scale [VAS]), and radiological outcomes were evaluated. Results The arthroplasty group demonstrated significantly shorter surgical duration (78.3 ± 12.4 vs. 92.7 ± 15.8 minutes; p < 0.001), earlier mobilization (1.1 ± 0.8 vs. 2.4 ± 1.2 days; p < 0.001), and reduced hospital stays (4.8 ± 1.4 vs. 6.2 ± 1.7 days; p < 0.001). Postoperative complications were lower in the arthroplasty group (9%) compared to osteosynthesis (15%; p = 0.03). Functional recovery at 12 months favored arthroplasty, with higher HHS (89.3 ± 4.6 vs. 83.7 ± 6.3; p < 0.001) and lower VAS pain scores (1.8 ± 0.5 vs. 2.9 ± 0.8; p < 0.001). Radiological assessments confirmed satisfactory fracture healing in 91% of osteosynthesis cases and implant stability in 97% of arthroplasty cases. Multivariate analysis identified arthroplasty as an independent predictor of shorter hospital stay (p = 0.02) and lower complication rates (p = 0.01). Conclusion Arthroplasty offers superior clinical outcomes in terms of faster recovery, fewer complications, and better functional scores compared to osteosynthesis for geriatric hip fragility fractures. These findings support arthroplasty as the preferred treatment in suitable elderly hip fracture patients, with further prospective studies recommended to strengthen the evidence base.