Outcomes of total hip arthroplasty and contralateral bipolar hemiarthroplasty.

Abstract

To The Editor: I read with dismay the well-intentioned case series “Outcomes of Total Hip Arthroplasty and Contralateral Bipolar Hemiarthroplasty. A Case Series” (2003;85:523-6), by Floren and Lester, regarding the outcome of total hip arthroplasty compared with contralateral bipolar hemiarthroplasty following a displaced subcapital hip fracture. Notwithstanding the small numbers involved (nine patients) and the reduced numbers at follow-up (just four patients at the final review), I have serious concerns regarding any conclusions drawn from the study. In a study of the outcome of a treatment, the subjects should have similar pathologies. In this series, bipolar hemiarthroplasty was performed because of a fractured femoral neck in eight of the nine cases and because of osteonecrosis in one. In contrast, total hip replacement was performed because of a fracture in only five of the nine cases and because of osteoarthritis or osteonecrosis in the remaining four. This difference in primary pathological process profoundly influences the outcome and surely precludes comparison. Greenough and Jones1 showed that the outcome of total hip replacement for the treatment of a fractured femoral neck was considerably worse than that for the treatment of degenerative conditions. The patients who had a total hip arthroplasty for the treatment of a degenerative condition rather … Corresponding author: D. Kevin Lester, MD, 6085 North First Street, Fresno, CA 93710, dklester{at}sbcglobal.net