Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study

Abstract

Purpose: To compare the short-term functional outcome between bipolar hip arthroplasty (BHA) and total hip replacement (THR) in displaced femoral neck fractures in elderly patients in a developing country.

Materials and methods: A prospective study was conducted which included a total of 42 patients of age more than 60 years with closed displaced femoral neck fractures, and the patients were randomized into two groups of 21 patients each and their outcomes were compared.

Results: At 24-month follow-up, patients in BHA group had a mean modified Harris hip score of 83.85 ± 6.62 and patients in THR group had a mean modified Harris hip score of 88.00 ± 5.76 (p value = 0.067). Seven (35%) patients in BHA group and 11 (55%) patients in THR group had hip scores from 91 to 100 (excellent), 9 (45%) patients in BHA and seven patients (35%) in THR had hip scores 81-90 (fair) and 4 (20%) patients in BHA group and 2 (10%) patients in THR group were rated 71-80 (good) and none was found in poor category. Total amount of blood loss while performing BHA was 238.15 ± 20.43 ml compared to 336.85 ± 23.56 ml in THR (p < 0.0001). Mean of total duration of surgery was found to be 51.80 ± 8.70 min in BHA group which was significantly lesser than 119.10 ± 16.75 min of THR group (p < 0.0001).

Conclusion: BHA being comparable to THR in terms of functional outcome by modified Harris hip scoring with significantly less blood loss during surgery, less duration of surgery, more cost-effective can be recommended as first line of surgical management in elderly patients with displaced femur neck fractures in developing countries.

Level of evidence: Level II, lesser-quality randomized controlled trial.

Keywords: Elderly; Harris hip score; Hemiarthroplasty; Total hip replacement.