Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up

Kanto, Kari; Sihvonen, Raine; Eskelinen, Antti; Laitinen, Minna

doi:10.1007/s00402-014-2053-1

Cited by 44 publications

(39 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Keeping in mind the mean age of living patients and those without revision surgery (91 years), the relatively low Harris hip score can be explained by the age-related disability of the individuals. Studies comparing two different types of surgical treatment (eg, bipolar vs unipolar hemiarthroplasty) found reasonable results regarding recovery of ambulatory status and activities of daily living for patients with bipolar hemiarthroplasties [14,21].…”

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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%

show abstract

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…25 Another potential advantage is a lower dislocation rate because of the two bearings. 26 However, the disadvantage of a bipolar HA is the possibility of prosthetic wear, and the higher cost.…”

Section: Comparisons Between Thr and Hamentioning

confidence: 97%

“…[27][28][29][30] A more recent prospective, randomized, controlled study comparing the use of unipolar versus bipolar heads did find a significantly lower dislocation rate in the bipolar group (6.8% versus 2.3%). 26 Therefore, we believe when performing HA, a bipolar head may be advantageous when available.…”

Section: Comparisons Between Thr and Hamentioning

confidence: 99%

Femoral neck fractures

2014

The Bone & Joint Journal

View full text Add to dashboard Cite

Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with IF, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred.

show abstract

“…26,27 A prospective study by Inngul et al 28 randomized 120 patients over the age of 80 yr with displaced femoral neck fracture into a unipolar HA treatment arm and a bipolar HA treatment arm. Known complications of the HA include groin pain from acetabular erosion, acetabular protusio, dislocation, and the need for a secondary operation.…”

Section: Arthroplastymentioning

confidence: 99%

Strategies for improving fixation in femoral neck fractures when replacement is not the best option

Ortega

Aderibigbe

2016

Current Orthopaedic Practice

View full text Add to dashboard Cite

Femoral neck fracture in elderly individuals remains a source of high morbidity and mortality with a reported 1-year mortality rate of 20-30%. Early mobilization and restoration to preinjury activity level should be guiding factors when treating elderly patients with femoral neck fractures. Most surgeons agree that the quality of fracture reduction continues to be the most important variable when assessing the success of femoral neck fracture fixation. Although there is still insufficient evidence to recommend an optimal method of fracture fixation in femoral neck fractures, primary fixation with a sliding screw device or cannulated, cancellous screws are widely used. Hip arthroplasty is often thought of as the main treatment for displaced femoral neck fractures in patients typically over 65 yr of age. However, as our elderly population continues to have an increased lifespan, a hip replacement may not be the best option for those who are physiologically young and active despite their advanced age. This article provides an overview of the classification, treatment options, and strategies for improving femoral neck fracture fixation in elderly patients and discusses the outcomes.

show abstract

Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up

Abstract: Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. However, both provide elderly patients with equal ambulatory ability and low revision rate at medium-term follow-up.

Cited by 44 publications

References 26 publications

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

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

Femoral neck fractures

Strategies for improving fixation in femoral neck fractures when replacement is not the best option

Contact Info

Product

Resources

About