Bipolar Hemiarthroplasty Research Articles

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

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.

A Prospective Study Comparing the Functional Outcome of Bipolar Hemiarthroplasty Versus Total Hip Replacement in Elderly Patients With Fracture of the Neck of Femur.

IntroductionDisplaced fractures of the neck of femur in elderly patients usually require surgical intervention, with either bipolar hemiarthroplasty (BHA) or total hip replacement (THR). However, there is still controversy regarding the optimal prosthesis. The present study was performed to compare the functional outcome of BHA versus THR in elderly patients with displaced fracture of the neck of femur.Materials and methodsThis prospective study was conducted between December 2019 and December 2021. This study included 40 patients with displaced fracture of the neck of femur. All patients were more than 60 years of age. The patients were randomly allocated to be treated with either BHA or THR. Functional assessment was done using Harris hip scores at one month, three months, six months, and one year postoperatively.ResultsIn our study, at all follow-ups, the Harris hip score was found to be more in patients in the THR group than in the BHA group. In the BHA group, the mean Harris hip scores were 59.95, 66.25, 68.80, and 75.70 at the follow-up visits at one month, three months, six months, and one year, respectively, while in the THR group, the mean Harris hip scores were 65.06, 69.40 72.50, and 78.19, respectively.ConclusionTHR is a better option as compared to BHA in the management of elderly patients with fracture of the neck of femur on account of less complication rates and higher Harris hip scores.

FUNCTIONAL OUTCOMES OF BIPOLAR HEMIARTHROPLASTY IN UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS

Background: Intertrochanteric fractures account for about 45% to 50% of all hip joint fractures in elderly patients. Conservative treatment carries the disadvantages of non-union and malunion, which in turn will increase the morbidity and mortality. Currently hemiarthroplasty and internal xation are the two considerable surgical options for xation for hip fractures. The purpose of this study was primarily to study functional recovery in patients with unstable intertrochanteric fractures treated with bipolar hemiarthroplasty while studying other relevant intraoperative and postoperative parameters of patients in these groups. 16 patients underwent bipolar Methods: hemiarthroplasty for unstable intertrochanteric femur fracture. Patients were evaluated in post-operative period for mobilization and full weight bearing. Harris hip score was used for functional evaluation on follow up visit for a period of 12months In our study the mean age (years) was Results: 73.31 ± 7.79. Seven (43.8%) of the participants had AO Type: A2.2 fracture, four patients (25.0%) had AO Type: A2.3, two (12.5%) of the participants had AO Type: A3.1. and three of them (18.8%) had AO Type: A3.3 fracture. The mean (SD) of Surgical Time (Minutes) was 111.50. The mean (SD) of Blood Loss (ml) was 491.25. The mean (SD) of Full Weight Bearing Day was 3.81. During the nal follow-up Excellent to fair results were obtained in 13 (81.25 %) cases and in 3 (18.75%) cases, results were poor. Bipolar hemiarthroplasty is suitable for intertroc Conclusions: hanteric fractures in elderly patients who have mechanically weak and porotic bones. Bipolar hemiarthroplasty has fair functional outcomes in unstable intertrochanteric femur fractures.

Osteointegration analysis with serial radiography as a predictor of successful cementless bipolar hemiarthroplasty at surabaya orthopaedic and traumatology hospital

Osteointegration is a direct structural relationship between the bone and the implant surface, a properly osseointegration implant can function without mobility. We aim to evaluate this process using serial radiological examinations, where characteristics such as bone sclerosis and cortical-periosteal thickening will be investigated. A retrospective analytic-observational study was conducted on 96 patients after cementless bipolar hemiarthroplasty operation from January 2012 to January 2021, examined for standing pelvic or hip anterior-posterior radiographs after six weeks, six months, and a year post-procedure at Surabaya Orthopaedic and Traumatology Hospital. Two musculoskeletal radiology consultants blindly evaluated for bone sclerosis, femoral stem positioning or stem angulation, cortical-periosteal thickening, and leg length discrepancy. The study was conducted on 24 male subjects (25%) and 72 female subjects (75%). Bone sclerosis significantly appeared in the six-month evaluation. There was no difference in femoral stem positioning. Cortical-periosteal thickening was found on the medial side according to the valgus position of the stem and began to appear in the 6-month evaluation and became more prominent after one year. No significant leg length discrepancy was found.

İntertrokanterik Femur Kırığı Tedavisinde Proksimal Femoral Çivileme ve Bipolar Hemiartroplasti Tekniklerinin İntraoperatif ve Postoperatif Sonuçlarının Karşılaştırılması

Aim: This study was undertaken with the purpose of comparing the short and long term surgical, clinical, and functional results between bipolar hemiarthroplasty and proximal femoral nailing in the same cohort of patients. Material and Methods: The retrospective scanning of two-year data of a tertiary care hospital has been carried out for patients with hip fractures undergoing proximal femoral nailing and bipolar hemiarthroplasty. 67 patients underwent proximal femoral nailing and 74 patients underwent bipolar hemiarthroplasty were included in the study. Each patient's short and long term outcomes were documented as well as their preoperative, intraoperative, and postoperative features. Results: There were no significant differences in the demographic features of both groups. The median intraoperative blood loss was significantly higher in the group who underwent bipolar hemiarthroplasty compared to the group who underwent proximal femoral nailing (450 cc vs 300 cc, respectively, p<0.001). It was found that the bipolar hemiarthroplasty procedure was associated with a greater need for intraoperative transfusion than the proximal femoral nailing procedure (p=0.007). Intraoperative complications were reported only in patients who underwent bipolar hemiarthroplasty. The need for intensive care unit was significantly higher in the bipolar hemiarthroplasty group than in the proximal femoral nailing group, with the rate of 86.5% (n=64) and 68.7% (n=46), respectively (p=0.011). Conclusion: According to the results of this study, the proximal femoral nailing procedure appears to be a more reliable surgical technique in patients with hip fractures in terms of both intraoperative complications and the postoperative need for an intensive care unit.

Treatment of Chronic Femoral Neck Fracture With Cemented Bipolar Hemiarthroplasty and Management of Intraoperative Fracture With Cerclage Cabling.

We cover the operative treatment of a neglected chronic femoral neck fracture nonunion treated at 6 months. We begin with a description of the case and concomitant injuries. The operative portion includes the direct lateral approach with the patient in lateral decubitus position, exposure of the fracture site, osteotomy of the neck, debridement of the nonunion site, broaching, trialing, recognition and treatment of an intraoperative proximal femur fracture using cerclage cabling above and below the lesser trochanter, cementation of final components, and reduction. We conclude with the patient's radiographs at 2 weeks and clinical outcome at 6-week follow-up.

A comparative study between osteosynthesis by proximal femoral nail (PFN) and Coxafemoral bypass with bipolar hemiarthroplasty Incomminuted inter- trochanteric fractures of femur in elderly patients

This study was done to compare osteosynthesis by Proximal Femoral Nail And coxa femoral bypass by Bipolar Hemiarthroplasty in Comminuted/ Unstable Inter- Trochanteric Fractures of Femur in Elderly patients. The study was Interventional, prospective study. The study was conducted at department of Orthopaedics at tertiary care centre. Sample size 60. Fractures included in this study were restricted to comminuted and unstable inter-trochanteric fractures. Evans classification type 3,4,5. patients were divided in 2 groups- Group A which was Operated by Proximal femoral nail (PFN) and Group B which was Operated by Bipolar Hemiarthroplasty.Pre-operative workup was done followed by Operation and post operatively physiotherapy was given. Follow up was taken at regular intervals. At each follow up Harris hip score was evaluated. The study concludes that, Coxa femoral bypass by bipolar hemiarthroplasty is a better option than proximal femoral nail in the treatment of unstable IT fractures in the elderly.

The Feasibility of Using the Direct Anterior Approach for Total Hip Arthroplasty or Bipolar Hemiarthroplasty to Treat Femoral Neck Fractures among the Elderly.

Purpose Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly. Total hip arthroplasty (THA) is the preferred treatment method in active, cognitively intact patients. In less active or cognitively impaired patients, bipolar hemiarthroplasty (BHA) is the practical option in Japan. Even with the direct anterior approach (DAA), clinical concerns about conducting THA in elderly patients include possible dislocations, critical complications, and medical cost-effectiveness. This study is aimed at rethinking the practical surgical indications for FNFs. Methods Between April 2019 and March 2021, BHA patients with displaced FNF (n = 21) performed through the DAA were compared with THA patients with displaced FNF (n = 19). The perioperative complications, clinical and radiologic outcomes, and mortality were compared between groups retrospectively at six months. Results THA patients had an increased average operation time (103.3 min vs. 89.1 min, P < 0.05) and similar amounts of bleeding (183.16 ml. vs. 121.1 ml.). The percentages of patients who received biological transfusion showed no difference, with low rates of perioperative complications (4% vs. 0%) and similar mortality rates compared to BHA patients. One THA patient experienced posterior dislocation during a state of postoperative delirium. Conclusion THA through the DAA might be a credible and safe option for FNF patients, with excellent functional outcomes and fewer surgery-related complications. Early posterior dislocation might be related to optimized offset distance and not related to leg discrepancy or other radiographic items. Hence, orthopedic surgeons should reconsider their options before conducting BPH for elderly and cognitively intact FNF patients.

Gunshot Wound to the Hip Resulting in a Femoral Head and Acetabulum Fracture Treated With Open Reduction and Internal Fixation and Bipolar Hemiarthroplasty

Combined fractures of the femoral head and acetabulum due to ballistic injuries are rare injuries, especially in the elderly. We present a case of a 70-year-old female who sustained a gunshot wound to the left hip, resulting in a comminuted femoral head fracture and posterior wall acetabular fracture. She was treated with open reduction and internal fixation of the acetabulum, as well as bipolar hemiarthroplasty for treatment of her femoral head fracture. At her 18-month follow-up visit, the patient was doing well and had no complaints.

Correlation between partial weight bearing with radiography osseointegration in post bipolar hemiarthroplasty cementless patients

A femoral neck fracture is a global health problem which mainly occurs among the elderly. Hip hemiarthroplasty is a popular modality in treating femoral neck fractures nowadays. Osseointegration refers to the structural binding between the bone and the implant surface; hence, a proper osseointegration of an implant will provide stable and functional anatomy. Early detection of osseointegration can make the clinician know prediction how the successful their operation. The aim of the study was to correlation a partial weight bearing with osseointegration using serial radiological examination where characteristics such as bone sclerosis and cortical-periosteal thickening. This study is a retrospective analytic-observational study conducted at Orthopaedic and Traumatology Surabaya Hospital, entailing 96 patients after cementless bipolar hemiarthroplasty operation from January 2012 to January 2021. Among patients with bipolar hemiarthroplasty female predominated the group with 75%, and the most frequent age group was between 71 and 80 years old. The most common the patient take partial weight bearing on day three post operation. There is positive correlation between sclerosis bone and cortical-periosteal thickening of pelvis radiographs that began to appear in the 6-week evaluation and became more prominent after one year.

Patients with femoral neck fractures treated by bipolar hemiarthroplasty have superior to unipolar hip function and lower erosion rates and pain: a systematic review and meta-analysis of randomized controlled studies.

We assessed acetabular erosion, hip function, quality of life (QoL), pain, deep infection, mortality, re-operation and dislocation rates in patients with displaced femoral neck fractures (dFNFs) treated with unipolar versus bipolar hemiarthroplasty at different postoperative time points. Relevant Randomized Controlled Trials (RCTs) were identified, following comprehensive literature research in Medline, Cochrane Central and Scopus databases, from conception until August 31th, 2021 and analyzed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Database research retrieved 120 studies; sixteen met eligibility criteria, providing 1813 (1814 hips) evaluable patients. Acetabular erosion was significantly higher for unipolar group at 6 and 12months (p = 0.02 and p = 0.01 respectively). Patients in the bipolar group presented significantly better hip function at 12 and 24months (p = 0.02 and p = 0.04 respectively). Postoperative pain was significantly less in the bipolar group at 12, 24 and 48months (p = 0.01). No statistically significant differences were found regarding the postoperative rates of deep infection, mortality, re-operation and dislocation. This study showed that patients with dFNFs treated with bipolar hemiarthroplasty have lower acetabular erosion rates at 6 and 12months postoperatively, better hip function at 12 and 24months, better QoL and less pain, when compared with unipolar. No statistically significant difference could be established regarding deep infection, mortality, re-operation and dislocation rates.

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus bipolar hemiarthroplasty for the treatment of elderly unstable comminuted intertrochanteric fractures

BackgroundAlthough proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for the elderly with unstable comminuted ITFs. The study aims to compare the curative effects of PFNA and cementless BHA on unstable comminuted ITFs in the elderly.MethodsFrom January 2012 to December 2016, we retrospectively reviewed 62 ITFs patients up to the inclusion and exclusion criteria in the study. Depending on the type of surgery, the patients were divided into two groups: Group BHA (n= 30) and Group PFNA (n = 32). The ITFs were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, weight bearing duration, Harris hip scores, 10-m walking speed, gait and postoperative complications were compared between the two groups.ResultsThere was no significant difference between the groups in hospital stay (P > 0.05). The BHA group trended to have a shorter operation time and a larger volume of blood loss (P < 0.01).The weight bearing duration was shorter in the BHA group than the PFNA group (P < 0.05).The Harris hip score was higher, the 10-m walking speed was faster and the gait was better in group BHA than group PFNA at three months postoperatively (P < 0.05), but there was no significant difference between the two groups at 6 and 12 months postoperatively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05).ConclusionThe BHA allows an earlier return to weight-bearing activity, but ultimately has the same effective treatments as the PFNA for the elderly with unstable comminuted ITFs.

A Prospective study of Outcomes of Bipolar Hemiarthroplasty in Young Adults for Avascular Necrosis of Femoral Head

A Prospective study of Outcomes of Bipolar Hemiarthroplasty in Young Adults for Avascular Necrosis of Femoral Head

Is Cemented Bipolar Hemiarthroplasty Good Choice For Unstable Intertrochanteric Fractures In Elderly: Multicentric Prospective Study At Karachi.

To analyse the functional outcome of primary cemented bipolar hemi arthroplasty (PCBH) for unstable osteoporotic intertrochanteric femur fractures in elderly patients. : It was a multicentre prospective study conducted at Institute of Orthopaedics & Surgery, Medicare Cardiac & General Hospital and Dr Ruth K M Pfau Civil Hospital Karachi, Pakistan from February 2015 to July 2020. Thirty-eight patients of 60-90 years of either gender diagnosed as close UIF, severe osteoporosis as per Singh index grade ≤3, time since injury <2 weeks, ASA status II & III and pre-injury independent walking were enrolled in this study. All patients with UIF underwent PCBH. The radiographs were performed before surgery and at intervals postoperatively. All patients were requested to come for follow up visits at 2 weeks, 4 weeks, 3 months, 6 months 1 year and then at 3 years to assess the functional outcome of patients. At first postoperative day check X-rays taken and rehabilitation started as per institutional rehabilitation protocol, at 2-week stiches removed, at 4 weeks' x-ray was done and all the patients were followed for 3 years. The primary outcomes were noted using Harris Hip Score (HHS) for the functional outcome assessed at the end of 1 year and at final follow up. The mean age of the study participants was 68.29±8.04 years. One male (2.6%) died at 6th month, then 2 females (5.2%) patients died at 1 year and 2 females (5.2%) patients died at the end of 3 years due to multiple comorbid conditions. During 1st year 3 patients (7.4%) developed DVT and 4 patients (10.5%) having diabetes and hypertension developed superficial wound infection. The mean Harris Hip Score between time points which indicated that the mean Harris Hip Score significantly improve over the period of time (p=0.001). Post hoc tests revealed that there were statistically significant differences between each time points (p<0.05). The functional outcome at 3 years, shown, one patient had excellent outcome, 24 patients had good outcome and 8 had fair outcome, respectively. The Primary Cemented Bipolar Hemiarthoplasty is a good choice of treatment in terms of reasonable functional outcome such as early mobilization and associated with less post-operative complications in elderly patients of UIF.

Hip fractures re-operation compared with death at two year in elderly patients: lowest risk of revision with dual mobility total hip arthroplasty than with bipolar hemiarthroplasty or internal fixation of Garden I and II.

This study determined at two year follow-up the lifetime risk of re-operation for elderly patients with hip fractures undergoing internal fixation, dual mobility total hip arthroplasty, or bipolar hemiarthroplasty, using death of the patient as a competing risk. With the hypothesis that arthroplasties may have less complications without increasing mortality even for Garden I and Garden II fractures, we retrospectively reviewed 317 hips with femoral neck fractures operated between January 2015 and August 2019. The mean age at time of surgical intervention was 82.4years (range 65 to 105). Sixty patients presented a nondisplaced hip fracture (Garden I or II) treated by internal fixtion (I-F), and 257 were treated by hip arthroplasty: 118 dual mobility total hip arthroplasty (DM-THA) and 139 with a bipolar hemiarthroplaty (B-H). Demographics, surgical and complications data, and mortality were collected and compared for each group. The overall mortality rate was 22.4% at two years, and similar (p = 0.98) in all groups, respectively 22%, 22%, and 23% for DM-THA, B-H, and I-F groups. With dual mobility THA, the cumulative incidence of re-operations for any reason was (lower (9%) than with internal fixation (22%) or bipolar hemiarthroplasties (19%). Using a double mobility total prosthesis does not increase the post-operative mortality of the patients, nor does it increase their survival. But, reducing the risk of complications certainly improves their quality of life during the little time they have left .

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases.

PurposeThe purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients.Materials and MethodsWe conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs.ResultsThe mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3-03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation.ConclusionBipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

Cementless bipolar hemiarthroplasty compared with proximal femoral nail anti-rotation of unstable intertrochanteric fractures in senile patients with osteoporosis: a retrospective study

BackgroundImplant design for the correction of osteoporotic unstable intertrochanteric fractures in elderly patients is a controversial issue. Our study aims to compare the efficacy of PFNA and cementless bipolar hemiarthroplasty (CBH) in treating osteoporotic unstable intertrochanteric fractures in the elderly.MethodsWe retrospectively assessed 70 elderly patients, aged > 70 years old, with intertrochanteric fractures (AO/OTA 31-A2 fractures) from 2014 to 2019. Among them, 34 patients received PFNA and 36 patients received CBH, accompanied with 2-year follow-ups. Additionally, the efficacy difference between the two implants was compared.ResultsBoth groups had similar general variables like age, gender, fracture site, degree of osteoporosis, fracture classification, ASA score, basic diseases, preoperative preparation time, anesthesia mode, amount of postoperative blood loss, hospital length of stay, along with postoperative blood transfusions and postoperative complications (P > 0.05). Conversely, significant differences were observed among intraoperative variables (amount of blood loss, amount of blood transfusions, operative time, number of intraoperative fluoroscopy), postoperative variables (weight-bearing time out of bed), and Harris hip function score within 12 months of operation (P < 0.05).ConclusionsCBH showed no obvious advantage over PFNA in the perioperative period in elderly patients with osteoporotic unstable intertrochanteric fractures. However, the joint replacement allowed for earlier ambulation after the operation and rapid recovery of the hip joint function.

Periarticular Injections after Bipolar Hemiarthroplasty

Periarticular Injections after Bipolar Hemiarthroplasty

Results of cementless and cemented bipolar hemiarthroplasty in proximal femur fractures with Dorr type B morphology

Aim: Surgical outcomes of patients, who had Dorr type B femoral morphology, were operated on with bipolar hemiarthroplasty for hip fracture were compared. Materials And Methods: This retrospective study included 352 patients with at least five years of follow-up. The patients were divided into two groups: cementless (Group 1; n = 136) and cemented (Group 2; n = 216). The study focused on the following parameters: admission cost, fracture type, gender, need for blood transfusion, Harris hip score (HHS), additional fracture, use of cement, mortality rate, revision surgery, the time between trauma and operation, duration of hospital stays, and surgery time. Results: The mean age of the patients in Group 2 was higher. Group 2 had a significantly longer duration of surgery and a higher need for blood transfusion than Group 1. The mean hemoglobin values of the patients in Group 2 was lower. The pertrochanteric femur fractures was more common than the neck of femur fractures in Group 2. The two groups did not differ by the parameters of the time between trauma and operation, mortality rate, revision surgery, duration of hospital stay, cost, and additional fracture. Conclusion: In this study, patients with femoral neck fractures were mainly operated on with cementless bipolar hemiarthroplasty, while patients with pertrochanteric femur fractures were primarily treated with cemented bipolar hemiarthroplasty.

A larger sized cup accelerates cartilage erosion of acetabulum after bipolar hemiarthroplasty in elderly with femur neck fracture.

Bipolar hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65–96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A – bipolar cup size > actual head size, Group B – cup size < head size, Group C – cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler line.The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0–4.4) and 4.15 ± 2.7 mm (range, 0–8.2) in Group A, 1.30 ± 1.3 mm (range, 0–3.8) and 4.11 ± 2.7 mm (range, 0–7.8) in Group B, and 0.90 ± 1.1 mm (range, 0–2.6) and 3.16 ± 2.9 mm (range, 0–7.9) in Group C (P = .039 and P = .187, respectively). The superior acetabular erosion showed significant difference between the 3 groups. During mean follow-up period of 12.3 years, 5 patients (5/117, 4.3%) underwent conversion to total hip arthroplasty due to superior acetabular erosion. All of 3 patient underwent BHA with a larger bipolar cup than the actual femoral head.A lager sized cup accelerated superior cartilage erosion of acetabulum after BHA. An optimal cup size should be considered when undergoing BHA in elderly patients.