Should We Use Bipolar Hemiarthroplasty in Patients ≥70 Years Old With a Femoral Neck Fracture? A Review of Literature and Meta-Analysis of Randomized Controlled Trials

Beauchamp-Chalifour, Philippe; Pelet, Stéphane; Belhumeur, Vincent; Angers-Goulet, Mathieu; Bédard, Luc; Belzile, Étienne L.

doi:10.1016/j.arth.2021.12.004

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…We con rm the earlier ndings from Sweden that the UHA is associated with a lower early reoperation / revision rate compared to the BHA [4]. Our long term results are supported by a recent meta-analyses that found a higher rate of acetabular erosion after UHA but no signi cant differences in revision rate, dislocation or Harris Hip Score (HHS) [2,3]. The included studies were however heterogenous and included outdated monoblock implants.…”

Section: Discussionsupporting

confidence: 86%

“…However, this has been di cult to show in clinical studies, and clinical equipoise still exist as whether the articulation in a hemiarthroplasty should be unipolar or bipolar. Metanalyses has shown similar results for BHA and UHA, with the exception of slightly less acetabular erosion with BHA, [2], [3]. A higher re-operation risk has been found for BHA compared to UHA in Sweden [4].…”

Section: Introductionmentioning

confidence: 64%

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Long-term risk of reoperation after modular hemiarthroplasty. Any differences between uni- or bipolar design?

Lind

Nåtman

Mohaddes

et al. 2023

Preprint

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Background It is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF). Aim We investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively. Methods In an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA patients, 12,280 were matched to a UHA control. A subgroup analysis based on the matched sample excluded individuals who died within 5 years and comprised 3,637 individuals with BHA and 3,537 with UHA. Kaplan-Meier survival analysis was used. Results In the Kaplan-Meier analysis, 92% of the BHA group was free from reoperation at 13 years (95% CI 0.91-0.93), compared to 92% in the UHA group (CI 0.89-0.94). BHA was associated with more reoperations until 3 years. Reoperation due to infection was most common after BHA, n=212 (1.7%) compared to n=141 (1.1%) after UHA. Dislocation led to reoperation in 192 of the BHA cases (1.6%) and in 157 of the UHA cases (1.3%). Acetabular erosion/pain occurred in 0.1% and 0.4%. Amongst those surviving ≥5 years, 93% of the BHA group was free from reoperation (CI 0.92-0.94) at 13 years, 92% after UHA (CI 0.90-0.94). BHA had more reoperations during the 1st year only. The causes for reoperations were similar results except for acetabular erosion/pain. Here the BHA group had 2 cases (0.1%), the UHA had 39 (1.1%). Conclusion With a modular hemiarthroplasty relatively few patients need a reoperation. During the first years, there is a higher reoperation rate after BHA compared to UHA. Thereafter, no differences are seen. In patients who survive ≥5 years after the fracture there are more reoperations due to acetabular erosion after UHA, but crude numbers are extremely low and the total reoperation rate is not affected.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 64%

Long-term risk of reoperation after modular hemiarthroplasty. Any differences between uni- or bipolar design?

Lind

Nåtman

Mohaddes

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…However, a meta-analysis of 14 RCTs demonstrated a reduced risk of acetabular erosion (RR, 0.38 [95% CI, 0.17 to 0.83]) and better hip function scores after 2 years (mean difference, 0.68 [95% CI, 0.18 to 1.18]) with bipolar compared with unipolar HA. However, the latter result came from trials with substantial heterogeneity, which limited the certainty of the result 14 . Tibia Tibial intramedullary nail insertion can proceed via a suprapatellar or infrapatellar approach.…”

Section: Hipmentioning

confidence: 99%