Comparison of the Short-Term Outcomes of Cementless Bipolar Hemiarthroplasty and Cementless Total Hip Arthroplasty for Displaced Femoral Neck Fractures in the Elderly

Abstract

Purpose: Displaced femoral neck fracture (DFNF) in elderly patients are frequently managed by hip replacement. However there is no consensus on bipolar hemiarthroplasty (BHA), which has a lower dislocation rate, less blood loss and shorter operative time, while total hip arthroplasty (THA) provides better functional and long term outcomes. This study aimed to evaluate patient function and complications following both BHA and THA in an elderly population who presented with DFNF. Methods: A prospective, randomized controlled trial comparing BHA and THA for DFNF treatment was performed. Patients over 60 years of age with DFNF (Garden’s classification types 3 and 4) participated in this study, while patients with preexisting hip conditions and impaired cognitive function were excluded from the study. All operations were performed by a single surgeon using the same techniques the posterior approach. Demographic data, intraoperative blood loss, operative time, and morbidity and mortality statistics were collected. Patients were followed up at 1, 3, 6 and 12 months and their functional scores were calculated according to the Harris hip score. Statistical analyses were performed to the intention-to-treat principle. Results: The cohort comprised 75 patients, with 38 patients in the BHA group (mean age 76.7 years) and 37 patients in the THA group (mean age75.7 years). The mean operative times for the BHA and THA groups were 40.76 and 51.08 minutes respectively. The average intraoperative blood loss was 200 cc and 279.7 cc, respectively. The mean hospital stay was 5.07 days for the BHA group and 4.92 days for the THA group. The mean Harris hip scores at 1, 3, 6 and 12 months in the BHA group were 71.5, 78, 85 and 86, respectively, while in those in the THA group were 71, 79, 85.5 and 88 respectively. Statistically, there were no significant difference between the two groups. Morbidities including fractures and dislocations, and mortality rates, also showed no statistically significant difference. Conclusions: Harris hip score, dislocation, length of hospital stay and mortality rate at one year is not statistically different between group. Blood loss and operative time were significantly lower in the BHA group than in the THA group.