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Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial

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Abstract

Purpose

The treatment of choice for a displaced femoral neck fracture in the most elderly patients is a cemented hemiarthroplasty (HA). The optimal design, unipolar or bipolar head, remains unclear. The possible advantages of a bipolar HA are a better range of motion and less acetabular wear. The aim of this study was to evaluate hip function, health related quality of life (HRQoL), surgical outcome and acetabular erosion in a medium-term follow-up.

Methods

One hundred and twenty patients aged 80 or more with a displaced fracture of the femoral neck (Garden III and IV) were randomised to treatment with a cemented Exeter HA using a unipolar or a bipolar head. All patients were able to walk independently, with or without aids, before surgery. Follow-ups were performed at four, 12, 24 and 48 months postoperatively. Assessments included HRQoL (EQ-5D index score), hip function (Harris hip score [HHS]) and radiological acetabular erosion.

Results

The mean EQ-5D index score was generally higher among the patients with bipolar hemiarthroplasties at the follow-ups with a significant difference at 48 months: unipolar HAs 0.59 and bipolar HAs 0.70 (p = 0.04). There was an increased rate of acetabular erosion among the patients with unipolar hemiarthroplasties at the early follow-ups with a significant difference at 12 months (unipolar HAs 20 % and bipolar HAs 5 %, p = 0.03). At the later follow-ups the incidence of acetabular erosion accelerated in the bipolar group, and there were no significant differences between the groups at the 24- and 48-month follow-ups. There was no difference in HHS or reoperation rate between the groups at any of the follow-ups.

Conclusion

The bipolar HAs seem to result in better HRQoL beyond the first two years after surgery compared to unipolar HAs. Bipolar HAs displayed a later onset of acetabular erosion compared to unipolar HAs.

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Acknowledgments

The authors wish to thank Hans Törnqvist, Department of Orthopaedics, Stockholm South Hospital (Södersjukhuset) and Jan Tidermark, Department of Orthopaedics, Capio St. Görans Hospital, Stockholm, Sweden for their valuable contribution to the study.

This study was supported in part by grants from the Trygg-Hansa Insurance Company, through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet and the Swedish Research Council (VR).

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Authors and Affiliations

  1. Karolinska Institutet, Department of Clinical Science and Education, Section of Orthopaedics, Södersjukhuset, Stockholm, Sweden

    Christian Inngul, Richard Blomfeldt, Sari Ponzer & Anders Enocson

  2. Karolinska Institutet, Department of Clinical Science and Education, Section for Orthopaedics, Danderyd Hospital, Stockholm, Sweden

    Carl-Johan Hedbeck

  3. Unilabs St. Göran Radiology, Capio St. Göran’s Hospital, Stockholm, Sweden

    Gunilla Lapidus

Authors
  1. Christian Inngul
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  2. Carl-Johan Hedbeck
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  3. Richard Blomfeldt
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  4. Gunilla Lapidus
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  5. Sari Ponzer
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  6. Anders Enocson
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Correspondence to Christian Inngul.

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Inngul, C., Hedbeck, CJ., Blomfeldt, R. et al. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial. International Orthopaedics (SICOT) 37, 2457–2464 (2013). https://doi.org/10.1007/s00264-013-2117-9

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  • DOI: https://doi.org/10.1007/s00264-013-2117-9

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