Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Nov;35(11):1703-11.
doi: 10.1007/s00264-011-1213-y. Epub 2011 Feb 8.

Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial

Carl Johan Hedbeck  1 , Richard Blomfeldt, Gunilla Lapidus, Hans Törnkvist, Sari Ponzer, Jan Tidermark
Affiliations
Randomized Controlled Trial

Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial

Carl Johan Hedbeck et al. Int Orthop. 2011 Nov.

Abstract

Purpose: Hemiarthroplasty (HA) is generally considered to be the treatment of choice in the most elderly patients with a displaced fracture of the femoral neck. However, there is inadequate evidence to support the choice between unipolar HA or bipolar HA. The primary aim of this study was to analyse the outcome regarding hip function and health-related quality of life (HRQoL) in patients randomised to either a unipolar or bipolar HA. The secondary aim was to analyse the degree of acetabular erosion and its influence upon outcome.

Methods: One hundred twenty patients with a mean age of 86 years and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar HA. Outcome measurements included hip function (Harris Hip Score, HHS), HRQoL (EQ-5D) and acetabular erosion. The patients were summoned at four and 12 months for follow-up.

Results: There were no significant differences between the groups regarding complications. The HHS scores were equal at both follow-ups, but there was a trend towards better HRQoL in the bipolar HA group at four months, EQ-5D (index) score 0.62 vs 0.54 (p = 0.06). Twenty percent of the patients in the unipolar HA group displayed acetabular erosion at the 12-month follow-up compared to 5% in the bipolar HA group (p = 0.03), and there were trends towards worse hip function and HRQoL among patients with acetabular erosion compared to those without: HHS scores 70.4 and 79.3, respectively (p = 0.09), and EQ-5D (index) scores 0.48 and 0.63, respectively (p = 0.13).

Conclusion: Unipolar HA and bipolar HA appeared to produce equivalent clinical outcomes after one year, but the significantly higher incidence of acetabular erosion in the unipolar HA group may imply that bipolar HA should be the preferred treatment.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Unipolar hemiarthroplasty
Fig. 2
Fig. 2
Bipolar hemiarthroplasty
Fig. 3
Fig. 3
Flow chart for all patients included (n = 120)
Fig. 4
Fig. 4
HRQoL (EQ-5D index score) before fracture and for all patients available at each follow-up (before fracture, n = 120; 4 months, n = 115; and 12 months, n = 99). * Two missing values in the unipolar group and one missing value in the bipolar group. p values given for differences between groups
See this image and copyright information in PMC

References

    1. Blomfeldt R (2006) Surgical treatment of patients with displaced femoral neck fractures. Aspects on outcome and selection criteria. Karolinska Institutet, Stockholm. http://diss.kib.ki.se/2006/91-7140-801-0/. Accessed 24 January 2011
    1. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–663.
    1. Tidermark J, Zethraeus N, Svensson O, Törnkvist H, Ponzer S. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma. 2002;16:34–38. doi: 10.1097/00005131-200201000-00008. - DOI - PubMed
    1. Bhandari M, Devereaux PJ, Tornetta P, 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122–2130. doi: 10.2106/JBJS.E.00535. - DOI - PubMed
    1. Rogmark C, Carlsson A, Johnell O, Sernbo I. 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. 2002;84:183–188. doi: 10.1302/0301-620X.84B2.11923. - DOI - PubMed

Publication types