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Reasons for revision of failed hemiarthroplasty: Are there any differences between unipolar and bipolar?

European Journal of Orthopaedic Surgery & Traumatology volume 28, pages 1117–1123 (2018)Cite this article

Abstract

Background

Hemiarthroplasty (HA) is an effective procedure for treatment of femoral neck fracture. However, it is debatable whether unipolar or bipolar HA is the most suitable implant.

Objective

The purpose of this study was to compare the causes of failure and longevity in both types of HA.

Materials and methods

We retrospectively reviewed 133 cases that underwent revision surgery of HA between 2002 and 2012. The causes of revision surgery were identified and stratified into early (≤ 5 years) failure and late (> 5 years) failure. Survival analyses were performed for each implant type.

Results

The common causes for revision were aseptic loosening (49.6%), infection (22.6%) and acetabular erosion (15.0%). Unipolar and bipolar HA were not different in causes for revision, but the unipolar group had a statistically significantly higher number of acetabular erosion events compared with the bipolar group (p = 0.002). In the early period, 24 unipolar HA (52.9%) and 28 bipolar HA (34.1%) failed. There were no statistically significant differences in the numbers of revised HA in each period between the two groups (p = 0.138). The median survival times in the unipolar and bipolar groups were 84.0 ± 24.5 and 120.0 ± 5.5 months, respectively. However, the survival times of both implants were not statistically significantly different.

Conclusions

Aseptic loosening was the most common reason for revision surgery after hemiarthroplasty surgery in early and late failures. Unipolar and bipolar hemiarthroplasty were not different in terms of causes of failure and survivorship except bipolar hemiarthroplasty had many fewer acetabular erosion events.

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References

  1. Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J. https://doi.org/10.1302/0301-620X.98B3

    Article  PubMed  Google Scholar 

  2. Parker MJ (2015) Hemiarthroplasty versus internal fixation for displaced intracapsular fractures of the hip in elderly men: a pilot randomised trial. Bone Joint J 97-B:992–996. https://doi.org/10.1302/0301-620X.97B7.35524

    Article  PubMed  CAS  Google Scholar 

  3. Frihagen F, Waaler GM, Madsen JE et al (2010) The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. Acta Orthop 81:446–452. https://doi.org/10.3109/17453674.2010.492763

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jiang J, Yang C-H, Lin Q et al (2015) Does arthroplasty provide better outcomes than internal fixation at mid- and long-term followup? A meta-analysis. Clin Orthop Relat Res 473:2672–2679. https://doi.org/10.1007/s11999-015-4345-3

    Article  PubMed  PubMed Central  Google Scholar 

  5. Prieskorn D, Burton P, Page BJ, Swienckowski J (1994) Bipolar hemiarthroplasty for primary osteoarthritis of the hip. Orthopedics 17:1105–1111

    PubMed  CAS  Google Scholar 

  6. Pellegrini VD, Heiges BA, Bixler B et al (2006) Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip. J Bone Joint Surg Am 88:1817–1825. https://doi.org/10.2106/JBJS.01879.pp

    Article  PubMed  Google Scholar 

  7. Muraki M, Sudo A, Hasegawa M et al (2008) Long-term results of bipolar hemiarthroplasty for osteoarthritis of the hip and idiopathic osteonecrosis of the femoral head. J Orthop Sci 13:313–317. https://doi.org/10.1007/s00776-008-1238-2

    Article  PubMed  Google Scholar 

  8. Warwick D, Hubble M, Sarris I, Strange J (1998) Revision of failed hemiarthroplasty for fractures at the hip. Int Orthop 22:165–168. https://doi.org/10.1007/s002640050233

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Sierra RJ, Cabanela ME (2002) Conversion of failed hip hemiarthroplasties after femoral neck fractures. Clin Orthop Relat Res 399:129–139

    Article  Google Scholar 

  10. Ulrich SD, Seyler TM, Bennett D et al (2007) Total hip arthroplasties: what are the reasons for revision? Int Orthop 32:597–604. https://doi.org/10.1007/s00264-007-0364-3

    Article  PubMed  PubMed Central  Google Scholar 

  11. Clohisy JC, Calvert G, Tull F et al (2004) Reasons for revision hip surgery. Clin Orthop Relat Res 429:188–192. https://doi.org/10.1097/01.blo.0000150126.73024.42

    Article  Google Scholar 

  12. Delaunay C, Hamadouche M, Girard J et al (2013) What are the causes for failures of primary hip arthroplasties in France? Clin Orthop Relat Res 471:3863–3869. https://doi.org/10.1007/s11999-013-2935-5

    Article  PubMed  PubMed Central  Google Scholar 

  13. Iamthanaporn K, Chareancholvanich K, Pornrattanamaneewong C (2015) Revision primary total hip replacement: causes and risk factors. J Med Assoc Thai 98:93–99

    PubMed  Google Scholar 

  14. Wroblewski BM (1984) Current trends in revision of total hip arthroplasty. Int Orthop 8:89–93

    Article  PubMed  CAS  Google Scholar 

  15. 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 4:117–120. https://doi.org/10.4055/cios.2012.4.2.117

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yang B, Lin X, Yin XM, Wen XZ (2015) 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. https://doi.org/10.1007/s00590-014-1565-2

    Article  PubMed  Google Scholar 

  17. Jia Z, Ding F, Wu Y et al (2015) Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 10:8. https://doi.org/10.1186/s13018-015-0165-0

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kanto K, Sihvonen R, Eskelinen A, Laitinen M (2014) 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. Arch Orthop Trauma Surg 134:1251–1259. https://doi.org/10.1007/s00402-014-2053-1

    Article  PubMed  Google Scholar 

  19. Kannan A, Kancherla R, McMahon S et al (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop 36:1–8. https://doi.org/10.1007/s00264-011-1354-z

    Article  PubMed  Google Scholar 

  20. Gjertsen J-E, Lie SA, Vinje T et al (2012) More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register. J Bone Joint Surg Br 94:1113–1119. https://doi.org/10.1302/0301-620X.94B8.29155

    Article  PubMed  Google Scholar 

  21. Hailer NP, Garellick G, Kärrholm J (2010) Uncemented and cemented primary total hip arthroplasty in the Swedish hip arthroplasty register. Acta Orthop 81:34–41. https://doi.org/10.3109/17453671003685400

    Article  PubMed  PubMed Central  Google Scholar 

  22. Giliberty RP (1983) Hemiarthroplasty of the hip using a low-friction bipolar endoprosthesis. Clin Orthop Relat Res 175:86–92

    Google Scholar 

  23. 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 35:1703–1711. https://doi.org/10.1007/s00264-011-1213-y

    Article  PubMed  PubMed Central  Google Scholar 

  24. Inngul C, Hedbeck CJ, Blomfeldt R et al (2013) Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Int Orthop 37:2457–2464. https://doi.org/10.1007/s00264-013-2117-9

    Article  PubMed  PubMed Central  Google Scholar 

  25. Georgiou G, Siapkara A, Dimitrakopoulou A et al (2006) Dissociation of bipolar hemiarthroplasty of the hip after dislocation. A report of five different cases and review of literature. Injury 37:162–168. https://doi.org/10.1016/j.injury.2005.09.014

    Article  PubMed  Google Scholar 

  26. Yuenyongviwat V, Iamthanaporn K, Hongnaparak T (2015) Spontaneous dissociation of bipolar hip hemiarthroplasty in a patient with nerve palsy: a case report and review of the literature. Int J Surg Case Rep 15:112–115. https://doi.org/10.1016/j.ijscr.2015.08.034

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to thank Siranart Kumpravat for the statistical analyses and to Glenn Shingledecker for reviewing the manuscript.

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Affiliations

  1. Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

    Khanin Iamthanaporn

  2. Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand

    Keerati Chareancholvanich & Chaturong Pornrattanamaneewong

Authors
  1. Khanin Iamthanaporn
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  2. Keerati Chareancholvanich
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  3. Chaturong Pornrattanamaneewong
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Corresponding author

Correspondence to Chaturong Pornrattanamaneewong.

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Iamthanaporn, K., Chareancholvanich, K. & Pornrattanamaneewong, C. Reasons for revision of failed hemiarthroplasty: Are there any differences between unipolar and bipolar?. Eur J Orthop Surg Traumatol 28, 1117–1123 (2018). https://doi.org/10.1007/s00590-018-2176-0

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  • DOI: https://doi.org/10.1007/s00590-018-2176-0

Keywords

  • Bipolar
  • Cause
  • Failure
  • Hemiarthroplasty
  • Revision
  • Unipolar