Clinical Outcomes of Bipolar Hemiarthroplasty versus Total Hip Arthroplasty: Assessing the Potential Impact of Cement Use and Pre-Injury Activity Levels in Elderly Patients with Femoral Neck Fractures

Abstract

Purpose This study was performed to analyze the potential impact of cement use and favorable pre-injury activity on clinical outcomes of bipolar hemiarthroplasty (BHA) compared with total hip arthroplasty (THA) in elderly patients with femoral neck fractures. Materials and Methods Systematic review and meta-analysis of 12 clinical studies (5 randomized controlled trials and 7 comparative studies). Subgroup analysis was performed based on type of fixation method (cemented vs. cementless) and in the patient with independent ambulation, respectively. Results A significantly higher dislocation rate was observed in patients treated with THA compared with those treated with BHA in individuals capable of independent ambulation before injury (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.62; P =0.05, Z=1.98). Also, the dislocation rate was significantly higher in patients treated with cemented THA compared with those treated with cemented BHA (OR, 0.18; 95% CI, 0.05–0.62; P =0.006, Z=2.73). EQ-5D was significantly higher in those treated with cemented THA compared with patients treated with cemented BHA. Lastly, HHS was significantly higher in patients treated with cementless THA compared with those treated with cementless BHA. Conclusion An increase in the dislocation rate was observed when THA was performed in elderly patients with femoral neck fracture and who were pre-injury independent walkers. In addition, cemented THA was associated with a higher dislocation rate compared with cemented BHA. However, the dislocation rate in those treated with cementless THA were similar to patients treated with cementless BHA. With regards to functional score, THA was superior to BHA in both cementless and cemented fixation.

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

“…For EQ-5D scores, our conclusion agreed with other studies that THA has better overall patients' quality of life ([24]; Y [28,48,49].). We did the subgroup analysis and found that the difference became obvious 2 years after the surgery.…”

“…Hospital and surgery outcomes For surgery time, almost all previous synthesized outcomes are in consistence with our results [24,28,33,48,49]. And we consider the main reasons are that HA requires less operative installation steps including cup preparation and implantation.…”

“…Many studies have proved better outcomes in THA group in terms of HHS but did not provide long-term results or subgroup analysis due to limited trials ( [24]; Y [28,33,49].). We made subgroups based on follow-up periods and initially found that THA group has higher total HHS in medium term (1-5 years) but no difference in short (< 6 months) or long terms (> 9 years).…”

“…Whether THA or HA is more applicable in FNF remains controversial [21]. Both pros and cons of the treatments were widely reported in previous studies and synthesized reviews but did not reach a common conclusion [6,11,13,15,17,24,26,33,[49][50][51][52]. The ongoing discussion requires highly reliable answers.…”

Relationship of femoral offset and clinical outcomes of femoral neck fracture patients following bipolar hip arthroplasty

“…Unlike unipolar hemiarthroplasty, BHA is designed to provide the inner bearing between the femoral head and the polyethylene surface and the outer bearing between the acetabular cup and the acetabulum [2][3][4] . Compared with THA, BHA is more frequently performed type of arthroplasty because this procedure is a less complicated surgery without acetabular replacement and has the advantage of an increased jumping distance that lowers the risk for dislocation 5) . Like in THA, the FO is important in BHA.…”