Objective  To explore the application value of stage rehabilitation intervention under the Health action process approach (HAPA) model (SRI-HAPAM) combined with tranexamic acid (TXA) in elderly patients with femoral neck fracture (FNF) undergoing total hip arthroplasty (THA).

Methods  Elderly FNF patients with unilateral THA in the First Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 were enrolled. According to the random number table method, the patients were divided into routine nursing (RN) group and TXA+SRI-HAPAM group. The RN group received conventional treatment after surgery, and the TXA+SRI-HAPAM group received TXA combined with SRI-HAPAM after surgery. The bleeding indexes [hidden blood loss (HBL), explicit blood loss (EBL) and blood transfusion volume (BTV)], and the levels of hemoglobin (Hb), C-reactive protein (CRP) and D-dimer (DD) were compared between the two groups at 24 h after surgery. The hip function [joint deformity (JD), joint function (JF), joint pain (JP), joint motion (JM) and total hip function (THF)], anxiety and depression [self-rating anxiety scale and self-rating depression scale], satisfaction with care, and complications were compared between the two groups at 3 months after surgery.

Results  A total of 100 elderly patients with unilateral THA due to FNF were included in the study, including 54 in the TXA+SRI-HAPAM group and 46 in the RN group. Before operation, there was no significant difference in Hb, CRP, DD, JD, JF, JP, JM, THF and SAS between the two groups (P>0.05). At 24 hours after operation, Hb decreased in the two groups, while CRP and DD increased (P<0.05), and the decrease in Hb and the increase in CRP and DD, as well as HBL, EBL and BTV in the TXA+SRI-HAPAM group, were lower than those in the RN group (P<0.05). At 3 months after operation, JD, JF, JP, JM and THF in both groups increased compared with those before operation, while SAS and SDS decreased compared with those before operation (P<0.05), and the functional scores of JD, JF, JP, JM and THF in the TXA+SRI-HAPAM group were significantly higher than those in the RN group, and the scores of SAS and SDS were lower than those in the RN group (P<0.05). 3  months after surgery, the nursing satisfaction of the TXA+SRI-HAPAM group was significantly higher than that of the RN group, and the total complication rate was lower than that of the RN group (P<0.05).

Conclusion  Compared the Routine nursing, TXA combined with SRI-HAPAM more effectively promotes postoperative recovery in patients with THA.

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