Abstract
Objective
To assess the safety and efficacy that compare bipolar hemiarthroplasty with unipolar hemiarthroplasty for the treatment of femoral neck fracture in the patient aged more than 65 years.
Methods
We searched databases including PubMed Central, MEDLINE (from 1966), EMBASE (from 1980) and the Cochrane Central Register of Controlled Trials database. Only prospective randomized controlled trials (RCTs) that compare bipolar hemiarthroplasty with unipolar hemiarthroplasty for the treatment of femoral neck fracture in the elder patient were included. RevMan 5.2 from the Cochrane Collaboration was applied to perform the meta-analysis.
Results
Six relevant RCTs with a total of 982 patients were retrieved. From this meta-analysis, mortality rates showed no statistical difference between two treatments, 14.7 % for bipolar versus 13.8 % for unipolar. The acetabular erosion rates were significantly different between two groups (P = 0.01), 1.2 % in bipolar versus 5.5 % in unipolar group. Overall complication rates, dislocation rates, infection rates and reoperation rates between two groups showed no statistical difference (P > 0.05). Neither of two treatments appeared to be superior regarding the clinical function assessed by Harris hip scores or return to pre-injury state rates (P > 0.05).
Conclusions
Both bipolar and unipolar hemiarthroplasty for the treatment of elderly patient suffering displaced femoral neck fracture achieve similar and satisfy clinical outcome in short-term follow-up. Unipolar hemiarthroplasty seems to be a more cost-effectiveness option for elderly patient.
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References
Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289
Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001
Wilson Victor, Huo Michael H et al (2004) Treatment of femoral neck fractures with prosthetic arthroplasty. J Curr Opin Orthop 15:18–21
Kannan A, Kancherla R, Mcmahon S et al (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orhtop 36:1–8
Kenzora J, Magaziner Z, Hudson J et al (1998) Outcome after hemiarthroplasty for femoral neck fractures in the elderly. Clin Orthop Relat Res 348:51–58
Calder SJ, Andeson GH, Jagger C et al (1996) Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians. J Bone Joint Surg Br 78:391–394
Cornell C, Levine D, O’Doherty J et al (1998) Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly. Clin Orthop Relat Res 348:67–71
Raia FJ, Chapman CB, Herrera MF et al (2003) Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 414:259–265
Davison JN, Calder SJ, Anderson GH et al (2001) Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. J Bone Joint Surg Br 83(2):206–212
Stoffel KK, Nivbrant B, Headford J et al (2013) Does a bipolar hemiprosthesis offer advantages for elderly patients with neck of femur fracture? A clinical trial with 261 patients. ANZ J Surg 83(4):249–254
Jeffcote B, Li MG, Barnet-Moorcroft A, Wood D et al (2010) Roentgen stereophotogrammetric analysis and clinical assessment of unipolar versus bipolar hemiarthroplasty for subcapital femur fracture: a randomized prospective study. ANZ J Surg 80(4):242–246
Hedbeck CJ, Blomfeldt R, Lapidus G et al (2011) Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. Int Orthop 35(11):1703–1711
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):1–34
Hozo SP, Djubegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
Leighton RK, Schmidt AH, Collier P, Trask K (2007) Advances in the treatment of intracapsular hip fractures in the elderly. Injury 38(3):S24–S34
Haidukewych GJ, Israel TA, Berry DJ (2002) Long-term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck. Clin Orthop Relat Res 403:118–126
Blewitt N, Mortimore S (1992) Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury 23:320–322
Enocson A, Hedbeck CJ, Törnkvist H et al (2012) Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop 36(4):711–717
Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg (Am) 64:1295
Leonardsson O, Kärrholm J, Åkesson K et al (2012) Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop 83(5):459–466
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Bing Yang and Xi Lin have contributed equally to this paper, both are first author.
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Yang, B., Lin, X., Yin, X.M. et al. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol 25, 425–433 (2015). https://doi.org/10.1007/s00590-014-1565-2
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DOI: https://doi.org/10.1007/s00590-014-1565-2