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
- 747 Downloads
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.
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.
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.
KeywordsHip fracture Surgery Elderly Hemiprosthesis Survival
- 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
- 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.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