High conversion rate to total hip arthroplasty after hemiarthroplasty in young patients with a minimum 10 years follow‐up

Background This study aimed to evaluate the follow-up results of bipolar hemiarthroplasty (BHA) for more than 10 years in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA. Methods This retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons. Results Reoperation was performed in 44 of the 114 patients (38.6 %). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2 % at 5 years, 48.8 % at 10 years, and 25.9 % at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years. Conclusions The minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient’s choice, keeping in mind that long-term survival cannot be guaranteed.

A Larger Sized Cup Accelerates Cartilage Erosion of Acetabulum after Bipolar Hemiarthroplasty in Elderly with Femur Neck Fracture

Purpose: Bipolar Hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.Patients and Methods: We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65-96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A- bipolar cup size > actual head size, Group B- cup size < head size, Group C- cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler’s line.Results: The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0 – 4.4) and 4.15 ± 2.7 mm (range, 0 – 8.2) in Group A, 1.30 ± 1.3 mm (range, 0 – 3.8) and 4.11 ± 2.7 mm (range, 0 – 7.8) in Group B, and 0.90 ± 1.1 mm (range, 0 – 2.6) and 3.16 ± 2.9 mm (range, 0 – 7.9) in Group C (p=0.039 and p=0.187, respectively). The superior acetabular erosion showed significant difference between the three groups. During mean follow-up period of 12.3 years, five patients (5/117, 4.3%) underwent conversion to THA due to superior acetabular erosion. All of three patient underwent BHA with a larger bipolar cup than the actual femoral head.Conclusion: A lager sized cup accelerated superior cartilage erosion of acetabulum after bipolar hemiarthroplasty. An optimal cup size should be considered when undergoing BHA in elderly patients.

Meta-analysis of unipolar and bipolar hemiarthroplasty for femoral neck fractures

Background Femoral neck fracture is a common fracture in the elderly. Improper treatment seriously impacts the patient and could potentially shorten their lifespan. Hemi-arthroplasty is a common treatment for femoral neck fractures, but the selection of unipolar prosthesis or bipolar prosthesis is still a controversial issue. Therefore, we conducted this comprehensive meta-analysis to compare the outcomes of unipolar and bipolar prostheses. Methods We searched the PubMed, EMbase, The Cochrane Library, and Web of Science databases for randomized controlled trials and cohort studies comparing unipolar hemiarthroplasty and bipolar hemiarthroplasty. The revised Jadad scale or Newcastle-Ottawa Scale was used to assess the quality of the included studies. After data extraction, continuous data were expressed as standardized mean differences and binary data were expressed as odds ratio. The postoperative infection, mortality, acetabular erosion rate, dislocation rate, and Harris hip score were compared and analyzed with Stata software. Results Nineteen studies that compared unipolar and bipolar replacement were included in the meta-analysis. We found no significant differences in the postoperative infection, mortality, dislocation rate, or Harris hip score between unipolar and bipolar replacement. The rate of acetabular erosion in the unipolar group was slightly higher than that in the bipolar group. Conclusions Existing studies have revealed that bipolar hemiarthroplasty is superior to unipolar hemiarthroplasty for femoral neck fractures in terms of acetabular erosion.

High Conversion Rate to Total Hip Arthroplasty after Hemiarthroplasty in Young Patients: Single-center, Retrospective Comparative Cohort Study with a Minimum Follow-up of 10 Years

Background: This study aimed to evaluate the long-term results of bipolar hemiarthroplasty (BHA) in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA. Methods: This retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons.Results: Reoperation was performed in 44 of the 114 patients (38.6%). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2% at 5 years, 48.8% at 10 years, and 25.9% at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years.Conclusion: The minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient’s choice, keeping in mind that long-term survival cannot be guaranteed.

The comparison between total hip arthroplasty and hemiarthroplasty in patients with femoral neck fractures: a systematic review and meta-analysis based on 25 randomized controlled trials

Background We performed an updated systematic review and meta-analysis which enrolled 25 prospective randomized controlled trials (RCTs) to compare the outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs). Methods We searched English databases which included PubMed, Embase (vis OvidSP), The Cochrane Library, and Web of Science, and Chinese databases Chinese National Knowledge Infrastructure (CNKI), VIP, Wang Fang, and China Biology Medicine Disc (CBM) in July 2020. The quality of each study was assessed according to the Cochrane Collaboration’s Risk of Bias. Risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were pooled with random-effects models. Data regarding baseline characteristics, hospital and surgery outcomes, clinical outcomes, patients’ quality of life, common complications, prothesis-related complications, mortality, and costs were reported. Results A total of 25 RCTs involving 3223 patients (1568 THA and 1655 HA) were included. THA had longer hospital length (WMD = 0.721, P < 0.0001) and surgery time (WMD = 20.044, P < 0.0001), and more blood loss compared with HA (WMD = 69.109, P < 0.0001). THA showed better ratings in the Harris Hip Score during follow-up periods between 1 and 5 years while no differences within 6 months and after 9 years. THA was associated with higher quality-of-life EuroQol-5 Dimension (EQ-5D) scores after 2 years of surgery but no difference within 1 year. There was no difference in common complications. THA had significant higher rate of dislocation (WMD = 1.897, P = 0.002) and lower acetabular erosion (WMD = 0.030, P = 0.001). For mortality, there was no difference during all the follow-up periods except for slightly higher 2-year mortality after surgery. Conclusion This meta-analysis demonstrates that THA has better medium-term functional results and quality of life and lower acetabular erosion rate, while HA shows better in reducing hospital stay, surgery time, and blood loss and also has lower dislocation rate.

Problems in the Revision of Failed Moore Prosthesis

Over the years, Moore prosthesis has been described as a good option in the treatment of femoral neck fracture. Its main disadvantages are about femoral fixation and the acetabular erosion. Because of less cost, it still be used improperly and provide a large number of failures. Improper placement of the Moore prosthesis provide biomechanical disturbances of the arthroplasty. The insufficient of residual femoral neck length or the insufficient of metaphyseal fill are associated with the failure of the Moore arthroplasty. The aim of our study is to report and evaluate intraoperative findings and difficulties while we were convert failed aseptic Moore hemiarthroplasty into cemented total hip arthroplasty.

Rapid Acetabular Chondrolysis following Hemiarthroplasty of the Hip: A Poor Prognostic Sign

Both hemiarthroplasty and total hip arthroplasty have been well described as effective methods of management for displaced femoral neck fractures in the elderly. Acetabular erosion is a common long-term complication of hemiarthroplasty. We present a case in which rapid acetabular erosion occurs within weeks of hemiarthroplasty, ultimately leading to an acetabular fracture and need for revision to total hip arthroplasty. Early and rapid acetabular erosion following hip hemiarthroplasty has not been well documented in current literature. It may lead to acetabular fracture and may be secondary to infectious causes. If encountered, an infection workup should be initiated.