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Randomized Controlled Trial
. 2013 Dec;37(12):2457-64.
doi: 10.1007/s00264-013-2117-9.

Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial

Christian Inngul, Carl-Johan Hedbeck, Richard Blomfeldt, Gunilla Lapidus, Sari Ponzer, Anders Enocson
Randomized Controlled Trial

Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial

Christian Inngul et al. Int Orthop. 2013 Dec.

Abstract

Purpose: The treatment of choice for a displaced femoral neck fracture in the most elderly patients is a cemented hemiarthroplasty (HA). The optimal design, unipolar or bipolar head, remains unclear. The possible advantages of a bipolar HA are a better range of motion and less acetabular wear. The aim of this study was to evaluate hip function, health related quality of life (HRQoL), surgical outcome and acetabular erosion in a medium-term follow-up.

Methods: One hundred and twenty patients aged 80 or more with a displaced fracture of the femoral neck (Garden III and IV) were randomised to treatment with a cemented Exeter HA using a unipolar or a bipolar head. All patients were able to walk independently, with or without aids, before surgery. Follow-ups were performed at four, 12, 24 and 48 months postoperatively. Assessments included HRQoL (EQ-5D index score), hip function (Harris hip score [HHS]) and radiological acetabular erosion.

Results: The mean EQ-5D index score was generally higher among the patients with bipolar hemiarthroplasties at the follow-ups with a significant difference at 48 months: unipolar HAs 0.59 and bipolar HAs 0.70 (p = 0.04). There was an increased rate of acetabular erosion among the patients with unipolar hemiarthroplasties at the early follow-ups with a significant difference at 12 months (unipolar HAs 20% and bipolar HAs 5%, p = 0.03). At the later follow-ups the incidence of acetabular erosion accelerated in the bipolar group, and there were no significant differences between the groups at the 24- and 48-month follow-ups. There was no difference in HHS or reoperation rate between the groups at any of the follow-ups.

Conclusion: The bipolar HAs seem to result in better HRQoL beyond the first two years after surgery compared to unipolar HAs. Bipolar HAs displayed a later onset of acetabular erosion compared to unipolar HAs.

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Figures

Fig. 1
Fig. 1
Flow chart for all patients included. HA hemiarthroplasty, f-u follow-up, m month
Fig. 2
Fig. 2
Health related quality of life (mean EQ-5D index score) before fracture and at follow-ups. Missing values due to patients who declined; 4 months, n = 3; 12 months, n = 2; 24 months, n = 5; 48 months, n = 9. P-values are given for differences between groups
See this image and copyright information in PMC

References

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