Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials

Yang, Bing; Lin, Xi; Yin, Xiao Ming; Xi, Wen

doi:10.1007/s00590-014-1565-2

Cited by 33 publications

(30 citation statements)

References 21 publications

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“…Thus, the reoperation incidence in the bipolar HA group is expected to be at least the equivalent to unipolar HA. Two meta-analyses comparing unipolar and biopolar HA support this conjecture 57,58 . But in our analysis, unipolar cemented HA exhibited lower reoperation incidence than other managements, and notably lower than did bipolar HA.…”

Section: Discussionmentioning

confidence: 86%

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials

Zhang

Wang

Huang

et al. 2017

Sci Rep

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Displaced intracapsular femoral neck (AO type 31 B2/3) fractures have various treatments, including internal fixation (IF), unipolar uncemented hemiarthroplasty (HA), bipolar uncemented HA, unipolar cemented HA, bipolar cemented HA, uncemented total hip replacement (THR), and cemented THR. Systematic literature retrieval was performed from the databases to compare them in a network meta-analysis. Forty studies (85 arms) containing 6141 patients were included. Overall, our network meta-analysis rank the orders of 7 procedures in reoperation, mortality, dislocation and infection, which indicates that IF may provide the highest reoperation incidence, unipolar cemented HA may provide the lowest reoperation incidence; uncemented THR contributes the highest dislocation incidence; and bipolar uncemented HA provides the lowest infection incidence. No differences in mortality were observed among the treatments. This conclusion is indirect; higher-quality direct comparisons are required.

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Section: Discussionmentioning

confidence: 86%

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials

Zhang

Wang

Huang

et al. 2017

Sci Rep

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“…Meta-analyses of randomized control trials were recently made available. Jia et al 20 confirmed a similar or better outcome in hip function, hip pain and quality of life in patients with bipolar implants, while Yang et al 19 reported a significantly lower acetabular erosion rate in the bipolar group (1.2%) compared to the unipolar group (5.5%). Liu et al, 18 however, did not report a statistically significant difference between the two implants.…”

Section: Discussionmentioning

confidence: 88%

“…However, some studies have not demonstrated superior functional outcome of bipolar hemiarthroplasty compared with their unipolar counterparts. 12,[16][17][18][19][20][21][22] There are also downsides of the bipolar system. The cost of the bipolar prosthesis is generally higher than unipolar implants.…”

Section: Introductionmentioning

confidence: 99%

Modular bipolar hemiarthroplasty for fracture neck of femur using contemporary cementing technique: Long-term results of a single design

Mak¹,

Li²,

Lee³

et al. 2019

Journal of Orthopaedics, Trauma and Rehabilitation

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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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“…There are two main categories of hemi-arthroplasty prosthesis, when assessing head component utilised: unipolar hemi-arthroplasty (UH) (Figure 1A ) and bipolar arthroplasty (BH) (Figure 1B )[ 25 , 29 - 31 ]. An UH comprise a large single endo-prosthetic head component, while BH has both an endo-prosthetic “bipolar” head component and an inner metal bearing[ 25 , 29 - 31 ]. The theoretical benefit of the BH design, with its mobile bearing concept, is to reduce component-induced wear on the acetabulum[ 25 , 29 - 31 ].…”

Section: Prosthesis Head Component - Unipolar Vs Bmentioning

confidence: 99%

“…Despite the perceived simplicity of the hip hemi-arthroplasty procedure, there are a number of variations to the procedure[ 15 , 24 - 26 ]. These include the approach[ 26 - 28 ], the type of prosthesis head[ 25 , 29 - 31 ], the method of stem insertion[ 25 , 32 - 34 ], and the type of prosthesis assembly[ 35 ]. The optimal selection for each of these factors remains to be determined[ 15 , 24 - 26 ].…”

Section: Introductionmentioning

confidence: 99%

Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence?

Robertson

Wood

2018

WJO

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This editorial reviews and summarises the current evidence (meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach, two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component, three recent meta-analyses and one Cochrane review have found that while unipolar hemi-arthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up (up to 1 year), there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome, complication profile, functional outcome and acetabular erosion rates at longer-term follow-up (2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis, unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique, three recent meta-analyses and one Cochrane Review have found that, while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties, cemented prostheses have lower rates of implant-related complications (particularly peri-prosthetic femoral fracture) and improved post-operative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality, cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure, one recent meta-analysis has found that, while staples can result in a quicker closure time, there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore, either suture or staple wound closure techniques appear equally appropriate for hip hemi-arthroplasty procedures.

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Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials

Abstract: Both bipolar and unipolar hemiarthroplasty for the treatment of elderly patient suffering displaced femoral neck fracture achieve similar and satisfy clinical outcome in short-term follow-up. Unipolar hemiarthroplasty seems to be a more cost-effectiveness option for elderly patient.

Cited by 33 publications

References 21 publications

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials

Modular bipolar hemiarthroplasty for fracture neck of femur using contemporary cementing technique: Long-term results of a single design

Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence?

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