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Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 9, pp 1251–1259 | Cite as

Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up

  • Kari Kanto
  • Raine Sihvonen
  • Antti Eskelinen
  • Minna Laitinen
Trauma Surgery

Abstract

Introduction

The choice between unipolar and bipolar hemiarthroplasty for treatment of displaced intracapsular femoral neck fractures in elderly patients still remains controversial. Our objective was to compare series of elderly individuals with a displaced femoral neck fracture treated with either a cemented, modular unipolar or bipolar prosthesis with the same femoral component.

Materials and methods

A prospective, randomized controlled trial of 175 displaced intracapsular femoral neck fractures in patients over 65 years was randomly allocated to unipolar (88) and to bipolar (87) hemiarthroplasty group. The primary end point was implant survival. Secondary end points included difference in ambulatory ability and mortality. Follow-up evaluations were performed at 2 months, at 1, 3 and 5 years. Implant and patient survival were followed until 2/2012. Survival analyses were performed using Kaplan–Meier curves with log-rank test. Data were analyzed using Chi-square test and Student’s t test.

Results

Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. This did not translate into difference in revision rates at 8 years. Prosthetic survival ship was 0.98 (95 % Cl 0.94–1.00) in the unipolar group and 0.97 (95 % Cl 0.93–1.00) in the bipolar group. There were no statistically significant differences in ambulatory ability, possibility to return home mortality or early radiological acetabular erosion. There were significantly more one-time dislocations in the unipolar group, but there was no difference in incidence of revisions due to recurrent dislocations. The overall mortality rate was 6 % at 30 days, 9 % at 90 days, 16 % at 12 months, and 53 % at 5 years. There was no difference in mortality between the groups.

Conclusions

Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. However, both provide elderly patients with equal ambulatory ability and low revision rate at medium-term follow-up.

Keywords

Hip fracture Surgery Elderly Hemiprosthesis Survival 

References

  1. 1.
    Alazzawi S, Sprenger De Rover WB, Brown J, Davis B (2012) The conversion rate of bipolar hemiarthroplasty after a hip fracture to a total hip arthroplasty. Clin Orthop Surg 4(2):117–120PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ (2012) Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. Int Orthop 36(11):2219–2223PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J (2005) Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment. J Bone Joint Surg Br 87(4):523–529PubMedCrossRefGoogle Scholar
  4. 4.
    Bowling A (2005) Mode of questionnaire administration can have serious effects on data quality. Journal of public health 27(3):281–291PubMedCrossRefGoogle Scholar
  5. 5.
    Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ (1996) Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. J Bone Joint Surg Br 78(3):391–394PubMedGoogle Scholar
  6. 6.
    Coleman SH, Bansal M, Cornell CN, Sculco TP (2001) Failure of bipolar hemiarthroplasty: a retrospective review of 31 consecutive bipolar prostheses converted to total hip arthroplasty. Am J Orthop 30(4):313–319PubMedGoogle Scholar
  7. 7.
    Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289PubMedCrossRefGoogle Scholar
  8. 8.
    Cornell CN, Levine D, O’Doherty J, Lyden J (1998) Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly. Clin Orthop Relat Res 348:67–71PubMedCrossRefGoogle Scholar
  9. 9.
    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):206–212PubMedCrossRefGoogle Scholar
  10. 10.
    Foster AP, Thompson NW, Wong J, Charlwood AP (2005) Periprosthetic femoral fractures–a comparison between cemented and uncemented hemiarthroplasties. Injury 36(3):424–429PubMedCrossRefGoogle Scholar
  11. 11.
    Frihagen F, Nordsletten L, Madsen JE (2007) Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 335(7632):1251–1254PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Giliberty RP (1983) Hemiarthroplasty of the hip using a low-friction bipolar endoprosthesis. Clin Orthop Relat Res 175:86–92PubMedGoogle Scholar
  13. 13.
    Gjertsen JE, Vinje T, Engesaeter LB et al (2010) Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am 92(3):619–628PubMedCrossRefGoogle Scholar
  14. 14.
    Hedbeck CJ, Blomfeldt R, Lapidus G, Tornkvist H, Ponzer S, Tidermark J (2011) Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. Int Orthop 35:1703–1711PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Hunger M, Thorand B, Schunk M et al (2011) Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health and quality of life outcomes 9:53PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Iorio R, Schwartz B, Macaulay W, Teeney SM, Healy WL, York S (2006) Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons. The Journal of arthroplasty 21(8):1124–1133PubMedCrossRefGoogle Scholar
  17. 17.
    Kannan A, Kancherla R, McMahon S, Hawdon G, Soral A, Malhotra R (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop 36(1):1–8PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2006) Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 88(2):249–260PubMedCrossRefGoogle Scholar
  19. 19.
    Keene GS, Parker MJ (1993) Hemiarthroplasty of the hip–the anterior or posterior approach? A comparison of surgical approaches. Injury 24(9):611–613Google Scholar
  20. 20.
    Pajarinen J, Savolainen V, Tulikoura I, Lindahl J, Hirvensalo E (2003) Factors predisposing to dislocation of the Thompson hemiarthroplasty: 22 dislocations in 338 patients. Acta Orthop Scand 74(1):45–48PubMedCrossRefGoogle Scholar
  21. 21.
    Parker MJ, Gurusamy K (2006) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. The Cochrane database of systematic reviews 3:CD001706PubMedGoogle Scholar
  22. 22.
    Phillips JR, Moran CG, Manktelow AR (2013) Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture. Injury 44(6):757–762PubMedCrossRefGoogle Scholar
  23. 23.
    Phillips TW (1987) The Bateman bipolar femoral head replacement. A fluoroscopic study of movement over a four-year period. J Bone Joint Surg Br 69(5):761–764PubMedGoogle Scholar
  24. 24.
    Raia FJ, Chapman CB, Herrera MF, Schweppe MW, Michelsen CB, Rosenwasser MP (2003) Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 414:259–265PubMedCrossRefGoogle Scholar
  25. 25.
    Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur–13 year results of a prospective randomised study. Injury 31(10):793–797PubMedCrossRefGoogle Scholar
  26. 26.
    Rogmark C, Carlsson A, Johnell O, Sernbo I (2002) A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years. J Bone Joint Surg Br 84(2):183–188PubMedCrossRefGoogle Scholar
  27. 27.
    Sarvilinna R, Huhtala H, Pajamaki J (2005) Young age and wedge stem design are risk factors for periprosthetic fracture after arthroplasty due to hip fracture. A case-control study. Acta orthopaedica 76(1):56–60CrossRefGoogle Scholar
  28. 28.
    Varley J, Parker MJ (2004) Stability of hip hemiarthroplasties. Int Orthop 28(5):274–277PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Verberne GH (1983) A femoral head prosthesis with a built-in joint. A radiological study of the movements of the two components. J Bone Joint Surg Br 65(5):544–547PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kari Kanto
    • 1
  • Raine Sihvonen
    • 1
  • Antti Eskelinen
    • 2
  • Minna Laitinen
    • 2
    • 3
  1. 1.Department of OrthopedicsHatanpää HospitalTampereFinland
  2. 2.Coxa Hospital for Joint ReplacementTampereFinland
  3. 3.Department of Orthopedics and Traumatology, Unit of Musculoskeletal SurgeryUniversity Hospital of TampereTampereFinland

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