Comparison of Bipolar Hemiarthroplasty with Total Hip Arthroplasty for Displaced Femoral Neck Fractures A Concise Four-Year Follow-up of a Randomized Trial

Department of Orthopaedics, Södersjukhuset, Stockholm, Sweden.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 03/2011; 93(5):445-50. DOI: 10.2106/JBJS.J.00474
Source: PubMed


We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5D(index)] score) was better in the total hip arthroplasty group at the time of each follow-up, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck.

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Available from: Gunilla Lapidus, Jan 30, 2015
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    • "Allocation concealment by either a sealed-envelope technique [11], [12] or computer automation based distribution [13], [14] was performed in four studies while the remained four were unclear [15]–[18]. In terms of blinding, it was “unclear” for four trials, “no” for two [11], [15] and “yes” for two [14], [16]. All the randomized trials were free of selective reporting. "
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    ABSTRACT: Background Displaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis. Methods A literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted. Results A total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: −7.11, 95%:−10.70,−3.53) one year postoperatively and the advantage kept over (SMD: −6.91, 95%:−12.98, −0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19). Conclusion Even though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.
    PLoS ONE 05/2014; 9(5):e98071. DOI:10.1371/journal.pone.0098071 · 3.23 Impact Factor
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    • "Old age, female gender, previous hip surgery, malpositioned implant components, postero-lateral surgical approach and limited caseload volume are all associated with increased risk for instability. Another important factor is the indication for arthroplasty i.e. the incidence of dislocation after femoral neck fracture is between 2% and 22% and after primary arthroplasty 1.7% and 3.9%.1-4 After revision surgery the incidence of dislocation increases up to 35%.5,6 "
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    ABSTRACT: Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.
    Orthopedic Reviews 06/2013; 5(2):48-51. DOI:10.4081/or.2013.e10
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    • "Acetabular erosion is thought to be the major factor influencing clinical outcome and reason of revision or conversion. Studies regarding acetabular erosion in patients with hemiarthroplasties show ranges from 2% to 36% for unipolar, and 0% to 26% for bipolar implants [13,14,18,22,41,42]. Baker et al [14]. "
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    ABSTRACT: Background The failure scenario in total hip arthroplasty (THA), in younger patients, is dependent on the fixation and wear of the acetabular component. In selected cases, where endoprosthetic replacement of the femoral head is unavoidable for limb salvage or functional recovery, hemiarthroplasty can be chosen as an alternative. The purpose of this study is to evaluate hemiarthroplasty as treatment strategy for young patients with osteonecrosis or a tumour of the proximal femur. Methods Between 1985 and 2008, 42 hemiarthroplasties (unipolar and bipolar) were performed in patients younger than 65 years with osteonecrosis (n=13) or a tumour of the proximal femur (n=29). All patients were seen at yearly follow-up examination and evaluated. Revision or conversion to a THA was regarded as a failure of the implant. A Kaplan Meier analysis was performed. To determine significant differences between categorical groups, the Pearson chi-square test was used. In numerical groups the independent T-test and One-way ANOVA were used. Results After a mean follow-up of 7.1 years, failure of the hemiarthroplasty occurred 6 times. The Kaplan Meier survival analysis with conversion to THA or revision as endpoint of the bipolar hemiarthroplasties (n=38) shows a 96% survival at 15, and 60% at 20 years. In the unipolar type (n=4) we found a conversion rate of 50% within 3 years. Conclusions Bipolar hemiarthroplasty is a reasonable alternative in a young patient with osteonecrosis or a tumour of the proximal femur as indication. Because of the high conversion rate after unipolar hemiarthroplasties, we would not recommend this type of prosthesis in the young patient.
    BMC Musculoskeletal Disorders 01/2013; 14(1):31. DOI:10.1186/1471-2474-14-31 · 1.72 Impact Factor
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