Comparison of Bipolar Hemiarthroplasty with Total Hip Arthroplasty for Displaced Femoral Neck Fractures

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.

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

“…This is the conclusion in a Cochrane review in which THA in a majority of relatively young and healthy patients had significantly less residual pain and better function at 1, 2, and 4 years after fracture at the cost of increased risk of dislocation and increased surgical time [28], also shown by Hedbeck et al [16]. A cost-effectiveness analysis concluded that it is likely that THA is associated with increased costs in the initial 2-year period, but the longerterm costs favor THA as a result of lower revision rates [4].…”

Femoral neck fractures in Lithuania and Sweden. The differences in care and outcome

“…One may suspect that the significant differences in the types of prostheses used might influence comparisons of the functional and quality of life outcomes between the two institutions. However, recent studies showed that there was no significant difference in quality of life in the short-term follow-up when bipolar or THA was implanted in patients with FNFs [10,11].…”

High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

“…This did not occur in our series, and the 30-day mortality in another series [20] of more than 7000 patients undergoing THAs for a hip fracture is 2.4%, consistent with our observation. Two randomized trials showed similar mortality rates with THA compared with other treatment options [9,18]. Therefore, it would seem that increasing age and medical comorbidities [16], rather than the magnitude of the surgical procedure, influence mortality.…”

“…In addition to these considerations, the initial experience with THA for intracapsular fractures suggest rates of dislocation ranging from 2% to 9% [3,4,10,15,23,26]. However, there is an accumulating body of evidence that supports the use of THA in suitable patients, and some studies [4,9,14,18,27] indicate function may be better than after other procedures, particularly hemiarthroplasty. To confirm or refute the reported higher rate of dislocation and recurrent dislocation in patients treated with THAs, we compared patients treated with hemiarthroplasty with patients treated with THA to determine the incidence of first-time dislocation, cumulative risk of dislocation, and influence of demographic factors.…”

“…First, we did not randomize the patients into the two groups. However, we believe it is reasonable to compare the two groups, as we could identify (Table 1) only five studies in which a hemiarthroplasty with cement was compared with a THA with cement [2,7,9,14,18]. Second, the surgeons performed the two procedures at two different times; however, the surgeons were the same and used the same approaches and perioperative treatments.…”