Arthroplasty options in femoral-neck fracture: answers from the national registries

Kannan, Arun; Kancherla, Ramprasad; McMahon, Stephen; Hawdon, Gabrielle; Soral, Aditya; Malhotra, Rajesh

doi:10.1007/s00264-011-1354-z

Cited by 83 publications

(63 citation statements)

References 15 publications

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“…Another complication was acetabular erosion, which was believed to cause pain and impaired hip function [12]. Data from national registries indicate that only 5.1 % of revisions in Australia and 4.7 % in Sweden were attributable to acetabular erosion [24]. In theory, bipolar HA reduces stress on the acetabular surface and thereby reduces acetabular erosion.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures

Liu

Tao

Wang

et al. 2014

International Orthopaedics (SICOT)

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Purpose Unipolar and bipolar hemiarthroplasty (HA) are used to treat displaced femoral-neck fractures. However, which type is best for treating displaced femoral-neck fractures in elderly patients remains a subject for debate. Our aim was to review randomised controlled trials to establish which type provides superior clinical outcome for this patient population. Methods We searched PubMed, Embase and Cochrane Register of Controlled Trials databases and Web of Science for randomised controlled trials (RCTs) comparing unipolar with bipolar HA to treat femoral-neck fracture in the elderly. Risk ratios (RRs) and mean differences (MDs) from each trial were pooled using random-effects or fixed-effects models depending on study heterogeneity. Analysis was performed using RevMan5.2 from the Cochrane Collaboration. Results A total of 1,100 patients from nine studies were assessed in this meta-analysis. Results showed no significant differences in function score [MD=−0.14, 95% confidence interval (CI) −2.42-2.13], mortality (RR=0.97, 95% CI 0.65-1.46), dislocation (RR=1.33, 95 % CI 0.53-3.34), deep infection (RR=0.79, 95 % CI 0.35-1.79), acetabular erosion (RR=1.99, 95 % CI 0.61-6.52), operating time (MD=2.14, 95 % CI −9.85 to14.14), blood loss (MD=13.40, 95 % CI −49.60 to 76.39) and length of hospital stay (MD=0.12, 95 % CI −0.49to0.73) between unipolar and bipolar HA. Conclusions Unipolar and bipolar HA achieved similar clinical outcomes in patients with displaced femoral-neck fractures.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures

Liu

Tao

Wang

et al. 2014

International Orthopaedics (SICOT)

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“…Comparable studies do not report on the outcome for patients who are living and those who have not undergone revision surgery [6,11,15,20]. LaBelle et al [13] reported a 10% Fig. 1 The graph shows the cumulative incidence of revision when patient death was considered as a competing risk (20-year rate = 3.5%).…”

Section: Discussionmentioning

confidence: 99%

“…The radiographic data showed that the implants continued to function well mechanically at long-term followup in the few remaining patients. Because some studies of bipolar hemiarthroplasties are registry-based, they do not include a radiographic analysis [6,12,13,19].…”

Section: Discussionmentioning

confidence: 99%

“…Controversy exists regarding the relative merits of hemiarthroplasty versus THA for patients with displaced femoral neck fractures, with some data supporting improved function in selected patients treated with THA [1,3,4,6,8,10,13,17,18,26]. It is important to understand short-and mid-term clinical results and the long-term likelihood of reoperation or revision of two commonly used treatment options, THA and bipolar hemiarthroplasty [12,18,26].…”

Section: Introductionmentioning

confidence: 99%

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Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond

Roth

Abdel

Harmsen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Displaced femoral neck fractures frequently are treated with bipolar hemiarthroplasties. Despite the frequency with which bipolar hemiarthroplasty is used to treat these fractures, there are few long-term data. Questions/purposes We sought to evaluate (1) the cumulative incidence of revision for any reason of bipolar hemiarthroplasties at 20 years, and the proportion of patients who lived more than 20 years who still have the prosthesis in situ from the index arthroplasty, (2) the cumulative incidence of aseptic loosening at 20 years, and (3) the Harris hip score of the surviving patients at long term.Methods We performed 376 cemented bipolar hemiarthroplasties for displaced femoral neck fractures in 359 patients between 1976 and 1985. At a minimum of followup of 20 years (mean, 24 years; range, 20-31 years), 339 of 359 patients (94%) were deceased, leaving 20 patients in the study group. Of those, one patient was confirmed to be lost to followup and two others had radiographic followup only. Three hundred fifty-nine patients (99.2%) (376 of the original 379 hips) were followed until death, revision of the hemiarthroplasty, or for at least 20 years (of clinical followup). Bipolar hemiarthroplasty was performed for displaced femoral neck fractures. Cemented fixation was the standard of care between 1976 and 1985 at our institution. The mean age of the patients at the time of surgery was 79 years (range, 60-99 years). The cumulative incidence of revision, estimated with death as a competing risk, and radiographs were evaluated for signs of aseptic loosening by a surgeon not involved in the clinical care of the patients. Clinical function was evaluated with the Harris hip score. The mean age of the patients at the time of surgery was 79 years. Results The 20-year cumulative incidence of revision for any reason was 3.5% (95% CI, 1.6%-5.3%). Of the 20 patients who survived more than 20 years, seven had the implant intact. The 20-year cumulative incidence of revision for aseptic loosening was 1.4% (95% CI, 0.2%-2.6%). The mean Harris hip score in patients who were still living and patient who did not have revision surgery was 63 ± 22, however 13 of the 20 patients had undergone revision surgery. Conclusions The long-term survivorship of bipolar hemiarthroplasty prostheses used to treat displaced femoral neck fractures in the elderly was high, and the procedure can be considered definitive for the majority of elderly patients with a femoral neck fracture. In this series, 6%

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“…On failure of these operations, a THR is indicated but the effect of these implants on the operative procedures and long-term outcomes of a subsequent THR has been debatable and not clear. 1,2 The conversion of failed hip hemiarthroplasty to THR has been associated with high rates of intra-and postoperative complications. 3,4 However, clinical experience has defined specific recurrent patterns of failure of hip hemiarthroplasty, 5,6 but there is no classification of these failures.…”

Section: Introductionmentioning

confidence: 99%

Revision of failed hip hemiarthroplasty. Classification, management, and follow-up

Morsi

Habib

Elseedy

et al. 2016

Journal of Orthopaedics

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Arthroplasty options in femoral-neck fracture: answers from the national registries

Abstract: Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival.

Cited by 83 publications

References 15 publications

Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures

Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures

Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond

Revision of failed hip hemiarthroplasty. Classification, management, and follow-up

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