Bipolar hemiarthroplasty versus total hip replacement in displaced femoral neck fracture in elderly

  • Dr. B. Mohan Choudhary Associate Professor, Department of Orthopaedics, Sri Ramachandra Medical College, Chennai, India
  • Dr Ganesan G Ram Associate Professor, Department of Orthopaedics, Velammal Medical College, Madurai, Tamil Nadu, India
Keywords: Neck of femur, Bipolar Hemiarthroplasty, Harris Hip score, Osteoporosis, Total Hip replacement

Abstract

Introduction: Fractures of the neck of the femur are commonly seen in the geriatric population resulting in significant morbidity and mortality. Primary arthroplasty helps in rapid mobilization while decreasing the chances of implant failure and complications such as deep vein thrombosis, pulmonary complications, infection, and bedsores. The purpose of this can be fulfilled either by Bipolar Hemiarthroplasty as well as by Total Hip arthroplasty. The aim of this study is to determine whether total hip replacement is clinically and functionally better than bipolar hemiarthroplasty in the neck of femur fracture in older patients.

Method: It is a prospective study done at Sri Ramachandra Medical College, Chennai, and Velammal Medical College, Madurai on 70 patients diagnosed with the unstable neck of femur fractures who were treated with bipolar hemiarthroplasty and total hip replacement from April 2018 to September 2019. The inclusion criteria were age more than 60 years and Unstable neck of femur fractures as per the Garden classification. The exclusion criteria were pathological fractures, associated fracture of lower limbs, and non-ambulatory patients prior to the injury. A functional assessment was carried out using the Harris Hip Score.

Results: In the group that underwent a total hip replacement, the mean Harris Hip Score was 70.6, 74.4, 77.68 and 80.95 at the follow-up visits at week 6, 3 months, 6 months and 1 year respectively. In the group that underwent bipolar hemiarthroplasty, the mean Harris Hip Scores were 63.50, 66.25, 68.72, and 71.26 at the follow-up visits at week 6, 3 months, 6 months and 1 year respectively.

Conclusion: Total hip arthroplasty is recommended over hemiarthroplasty for the displaced neck of femur fractures in elderly patients owing to the higher Harris Hip Scores and lower re-operation rates.

Downloads

Download data is not yet available.

References

Ram GG, Govardhan P. In-Hospital Mortality following Proximal Femur Fractures in Elderly Population. Surg J. 2019;5(02):e53-e56. doi: https://doi.org/10.1055/s-0039-1692995.

Van Embden D, Rhemrev SJ, Genelin F, Meylaerts SA, Roukema GR. The reliability of a simplified Garden classification for intracapsular hip fractures. Orthop Traumatol: Surg Res. 2012;98(4):405-408. doi: https://doi.org/10.1016/j.otsr.2012.02.003.

Ram GG, Rajesekaran R, Vignesh Jayabalan DP. Is Functional outcome of Cementless Total Hip Replacement better than cemented one?. Sch Acad J Biosci. 2016;4(2):110-113. doi: https://doi.org/10.36347/SAJB.2019.v07i11.011.

Bhandari M, Devereaux PJ, Tornetta III P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg. 2005;87(9):2122-30. doi: https://doi.org/10.2106/JBJS.E.00535.

Im G-I, Shin Y-W, Song Y-J. Potentially unstable intertrochanteric fractures. J Orthop Trauma. 2005;19(1):5-9. doi: https://doi.org/10.1097/00005131-200501000-00002.

Dawson D, Milligan D, Callachand F, Cusick L. Hip Hemi-Arthroplasty vs Total Hip Replacement for Displaced Intra-Capsular Hip Fractures: Retrospective Age and Sex Matched Cohort Study. The Ulster Med J. 2018;87(1):17.

Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age-which is the ideal modality of primary joint replacement?. Patient Safety Surg. 2010;4(1):16. doi: https://doi.org/10.1186/1754-9493-4-16.

Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res. 2012;470(8):2235-2243. doi: https://doi.org/10.1007/s11999-012-2293-8.

Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome analysis of hemiarthroplasty vs. total hip replacement in displaced femoral neck fractures in the elderly. J Clin Diagnos Res. 2016;10(5):RC11. doi: https://doi.org/10.7860/JCDR/2016/18638.7877.

Cordero-Ampuero J, de Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties?. Clin Orthop Relat Res. 2010;468(12):3268-3277. doi: https://doi.org/10.1007/s11999-010-1411-8.

Van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg. 2010;92(10):1422-1428. doi: https://doi.org/10.1302/0301-620X.92B10.24899.

Ferrata P, Carta S, Fortina M, Scipio D, Riva A, Di Giacinto S. Painful hip arthroplasty: definition. Clin Cases Miner Bone Metab. 2011;8(2):19-22.

CITATION
DOI: 10.17511/ijoso.2020.i02.07
Published: 2020-04-30
How to Cite
B. Choudhary, M., & G Ram, G. (2020). Bipolar hemiarthroplasty versus total hip replacement in displaced femoral neck fracture in elderly. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 6(2), 105-109. https://doi.org/10.17511/ijoso.2020.i02.07
Section
Original Article