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: 4.31). 03/2011; 93(5):445-50. DOI: 10.2106/JBJS.J.00474
Source: PubMed

ABSTRACT 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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    • "While re-osteosynthesis may be used in younger patients with good bone quality, a prosthetic replacement is preferred in elderly patients with osteoporotic bone, either as a total hip arthroplasty (THA) or as a hemiarthroplasty (HA) (Mariani and Rand 1987, Sarathy et al. 1995, Said et al. 2006). In the elderly patient with low functional demands and an intact acetabulum, an HA is an option, whereas a THA is an optimal alternative for a lucid patient with long life expectancy and higher functional demands (Hedbeck et al. 2011). "
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    ABSTRACT: Background and purpose Hip arthroplasty is an option for elderly patients with osteoporosis for the treatment of failure after fixation of trochanteric and subtrochanteric fractures, either as a total hip arthroplasty (THA) or as a hemiarthroplasty (HA). We analyzed the reoperation rate and risk factors for reoperation in a consecutive series of patients. Methods All patients (n = 88) operated from 1999 to 2006 with a THA (n = 63) or an HA (n = 25) due to failure of fixation of a trochanteric fracture (n = 63) or subtrochanteric fracture (n = 25) were included. Background data were collected from the patient records. A search was performed in the national registry of the Swedish National Board of Health and Welfare in order to find information on all reoperations. The follow-up time was 5–11 years. Results The reoperation rate was 16% (14/88 hips). A periprosthetic fracture occurred in 6 patients, a deep prosthetic infection in 5 patients, and a dislocation of the prosthesis in 3 patients. Standard-length femoral stems had an increased risk of reoperation (11/47) compared to long stems (3/41) (HR = 4, 95% CI: 1.0–13; p = 0.06). Interpretation The high reoperation rate reflects the complexity of the surgery. Using long femoral stems that bridge previous holes and defects may be one way to reduce the risk for reoperation.
    Acta Orthopaedica 05/2012; 83(5):493-8. DOI:10.3109/17453674.2012.688724 · 2.45 Impact Factor
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    • "However, the pain scores were similar. This difference in functional scores may be explained by the patients operated on with total arthroplasty being younger— even though a recent randomized study by Hedbeck et al. (2011) has indicated that total hip arthroplasty has a better outcome than hemiarthroplasty. Our results concerning migration are similar to those presented by Sköldenberg et al. (2011) who studied the uncemented fully HA-coated collared Biomet Fracture Stem. "
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    ABSTRACT: Today, dislocated femoral neck fractures are commonly treated with a cemented hip arthroplasty. However, cementing of the femoral component may lead to adverse effects and even death. Uncemented stems may lower these risks and hydroxyapatite (HA) coating may enhance integration, but prosthetic stability and clinical outcome in patients with osteoporotic bone have not been fully explored. We therefore studied fixation and clinical outcome in patients who had had a femoral neck fracture and who had received a fully HA-coated stem prosthesis. 50 patients with a dislocated femoral neck fracture were operated with the fully HA-coated Corail total or hemiarthroplasty. 38 patients, mean age 81 (70-96) years, were followed for 24 months with conventional radiographs, RSA, DEXA, and for clinical outcome. 31 of the 38 implants moved statistically significantly up to 3 months, mainly distally, mean 2.7 mm (max. 20 mm (SD 4.3)), and rotated into retroversion mean 3.3º (-1.8 to 17) (SD 4.3) and then appeared to stabilize. Distal stem migration was more pronounced if the stem was deemed to be too small. There was no correlation between BMD and stem migration. The migration did not result in any clinically adverse effects. The fully hydroxyapatite-coated Corail stem migrates during the first 3 months, but clinical outcome appears to be good, without any adverse events.
    Acta Orthopaedica 11/2011; 83(2):153-8. DOI:10.3109/17453674.2011.641107 · 2.45 Impact Factor
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    ABSTRACT: Severe osteoporosis is becoming a common problem faced by surgeons performing primary hip arthroplasty. As the population ages, osteoporosis is increasing, especially as the population aged more than 80 years increases. Patients may need a total hip replacement to treat osteoarthritis or an acute femoral neck fracture. Recent data have shown an advantage to hip replacement in this population. Although uncemented and cemented designs of femoral prostheses have been used successfully, there is a high rate of periprosthetic fracture associated with the use of uncemented stems in patients with osteoporosis. Successful replacement requires knowledge of the particular stem type used in the weakened proximal femur. Total hip replacement for fracture also has a higher rate of dislocation. Additional study is required to determine if a particular uncemented stem design is better than others in this scenario or whether more use of cemented stems would help to limit periprosthetic fracture.
    06/2013; 2(2). DOI:10.1007/s13670-013-0044-7
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