Abstract
<title>Abstract</title> <p> <bold>Background</bold> With the rising incidence of femoral neck fractures in the elderly, hemiarthroplasty via the posterolateral approach has been widely adopted. However, this approach inevitably damages the short external rotators and the posterior capsule, which are critical for hip stability, leading to a considerable risk of postoperative dislocation. Current research has shifted from simple mechanical repair to precise biomechanical reconstruction based on anatomical principles. Although various repair techniques have been proposed, challenges remain regarding excessive tension, secondary rupture, and inadequate restoration of native anatomy. Therefore, further investigation is warranted to achieve an optimal balance between immediate stability and functional recovery through an anatomical, tension-free reconstruction strategy. <bold>Methods</bold> A retrospective analysis was conducted on 124 elderly patients with unilateral femoral neck fractures who were admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from September 2023 to January 2025. All patients underwent a posterolateral approach. Based on clinical data and preoperative doctor-patient communication, the patients were divided into two groups: the anatomical biomimetic reconstruction group (n = 65) and the conventional suture group (n = 59). Operative time, intraoperative blood loss, incision length, wound healing, hospital stay, complication rates, and readmission rates were recorded for both groups. Postoperative outcomes, including visual analog scale score, Harris hip score, hip flexion-extension range of motion, and internal-external rotation range of motion, were compared between the two groups. The aim was to evaluate the clinical application value of anatomical biomimetic reconstruction of the external rotators combined with repair of the zona orbicularis in unilateral artificial femoral head replacement. <bold>Results</bold> All patients were followed up for 12 to 18 months. No significant differences were observed in preoperative baseline clinical data between the two groups. Regarding perioperative indicators, one patient in the trial group and two patients in the control group had grade B wound healing, all of which healed well after active anti-infection treatment and regular dressing changes. The trial group was significantly superior to the control group in terms of intraoperative blood loss and incision length (p < 0.05).The operative time in the trial group was longer than that in the control group, but the difference was not statistically significant (p > 0.05). No significant differences were found between the two groups in wound healing or hospital stay (P > 0.05). There was no significant difference in time to full weight-bearing between the two groups (P > 0.05). Compared with the control group, the trial group showed significantly better postoperative visual analog scale scores, Harris hip scores, hip flexion-extension range of motion, and internal-external rotation range of motion, indicating that the trial group had significantly better long-term prognosis.In terms of radiographic findings and complications, no prosthetic loosening, periprosthetic infection, or fracture was observed in either group during regular follow-up. No dislocation occurred during hospitalization in either group. After discharge, one case of dislocation occurred in the trial group and three cases in the control group; all dislocations were successfully reduced by closed manipulation under anesthesia. The difference was not statistically significant. <bold>Conclusions</bold> Anatomical biomimetic reconstruction not only ensures joint stability but also achieves better functional outcomes, with a higher proportion of patients returning to their pre-injury activity level compared with conventional reconstruction methods. This provides a new reference dimension for clinical surgical decision-making. </p>