A study of clinical, functional and radiological outcome of unipolar versus bipolar hemiarthroplasty in displaced fracture neck of femur in adults

Introduction: The use of bipolar prosthesis in the management of displaced fracture neck of femur has remained controversial. There has been a lack of long-term studies in its results and survivorship, especially in acetabular erosion. Methods: We retrospectively reviewed 108 single design bipolar hemiarthroplasties (105 patients) performed in a single centre between 1999 and 2008, with a mean follow-up of 7.4 years (range: 2.2–18.3 years). General indications of surgery include displaced fracture with age less than 75, narrow femoral canals not permitting the use of a monoblock implant or as salvage procedure for failed internal fixation. Results: Six hips (5%) required further surgery – two patients had debridement for infection and four patients required revision to total hip arthroplasty (THA) due to infection or aseptic loosening. There was no dislocation. No revision was required for acetabulum erosion. Kaplan–Meier analysis showed a 15-year survival free of revision due to any reason to be 93.1% and due to aseptic loosening to be 97.1%. Discussion: Our centre has shown excellent clinical results and low revision rate with the cemented bipolar system. In the context of displaced fracture neck of femur, the long-term results can be compared with THA which is associated with higher perioperative morbidity.

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Prospective study of the functional outcome of uncemented bipolar hemiarhroplasty in displaced fracture neck of femur in elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201736 ◽

2020 ◽

Vol 6 (3) ◽

pp. 567

Author(s):

Radhakrishna A. Mallegowda ◽

Channappa T. Seetharam ◽

Shivanand Sundaram ◽

Jayaram B. Siddegowda ◽

Veeresh Nijalingappa

Keyword(s):

Functional Outcome ◽

Early Mobilization ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Bipolar Prosthesis ◽

Fracture Neck Of Femur ◽

Excess Morbidity ◽

Predominantly Female ◽

Displaced Fracture

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity, mortality and loss of independence. To avoid the drawbacks of internal fixation and for early mobilization, hemiarthroplasty is performed in elderly. The bipolar prosthesis was developed to overcome the shortcomings of the unipolar fixed-head prosthesis. An additional site of motion would be expected to decrease the amount of loosening, dislocation, and head migration. The aim of the study is to assess the functional outcome of the patients with fracture neck of femur treated with bipolar hemiarthroplasty.Methods: In this study, 20 patients above the age of 60 years with acute displaced fracture neck of femur underwent hemireplacement arthroplasty with bipolar prosthesis in Department of Orthopaedics, KIMS, Bangalore. The patients were followed up on 6th, 12th, 18th, 24th week post operatively. Functional outcome was assessed with Harris hip score.Results: In our study, mean average age was 72.3 years with predominantly female patients with 75% of the patients with left sided fracture. 95% of the patients had slight or no pain, 85% of patients had slight or no limp. 50% of the patients could walk without support, 65% of the patients could walk a distance of 6 blocks or more. Average Harris hip score was 82%.Conclusions: These results suggest functional outcome following bipolar hemiarthroplasty is good. Early mobilisation, pain free hip and with good level of activity is obtained following bipolar hemiarthroplasty.

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