The efficacy of anatomical biomimetic reconstruction of the external rotator muscle group combined with repair of the annular ligament in hip replacement surgery

Background With the significant increase in the incidence of femoral neck fractures in the elderly, optimizing the selection of surgical techniques has important clinical value for improving outcomes and reducing perioperative risks. Currently, the focus of related research has shifted from mechanical structural repair to biomechanically precise reconstruction based on the principles of biomimetic medicine. Although the theory of anatomical reduction and repair is widely accepted, further research is still warranted to achieve an optimal balance between repair stability and joint mobility through personalized treatment strategies. Methods A retrospective cohort study was conducted involving 124 elderly patients with unilateral femoral neck fractures who were admitted to the Hospital between June 2021 and March 2023. All patients were operated on via a posterolateral approach. Based on comprehensive analysis of clinical data and preoperative physician–patient communication, 65 patients were assigned to the experimental group and underwent anatomical biomimetic reconstruction of the external rotators combined with repair of the zona orbicularis; the remaining 59 patients were assigned to the control group and received conventional suture repair (fixation of the joint capsule combined with the external rotator tendons to the greater trochanter). The following parameters were recorded for both groups: operative time, intraoperative blood loss, incision length, wound healing status, length of hospital stay, complication rate, and readmission rate. Postoperative outcomes including VAS score, Harris Hip Score, hip flexion–extension range of motion, and internal–external rotation range of motion were compared to evaluate the clinical utility of anatomical biomimetic reconstruction of the external rotators combined with zona orbicularis repair in unilateral hemiarthroplasty. Results The two groups demonstrated comparable baseline characteristics (p>0.05). Perioperatively, the experimental group showed significantly reduced intraoperative blood loss and shorter incision length (p<0.05), while operative time was longer but not statistically significant. Wound healing (1 vs. 2 cases of Grade B healing) and hospital stay were similar between groups. Functional outcomes significantly favored the experimental group, with improved VAS scores, Harris hip scores, and hip range of motion (flexion-extension and internal-external rotation). Radiographically, the experimental group achieved greater anteversion (p<0.05) with comparable acetabular abduction angle. No cases of prosthetic loosening, periprosthetic infection, or fracture occurred during follow-up. Dislocation rates after discharge (1 vs. 3 cases, p>0.05) did not differ significantly, though a numerical trend favoring the experimental group was observed. Conclusions Anatomical biomimetic reconstruction not only provides reliable joint stability but also enables superior functional outcomes, with a higher proportion of patients returning to their preinjury activity levels compared to conventional techniques. This offers a valuable perspective in the clinical decision-making process for surgical management.