Bipolar Hemiarthroplasty Group Research Articles

COMPARISON OF POSTOPERATIVE QUALITY OF LIFE AND UTILITY VALUES FOLLOWING TOTAL HIP ARTHROPLASTY AND BIPOLAR HEMIARTHROPLASTY FOR OSTEONECROSIS OF THE FEMORAL HEAD

Purpose: The appropriate surgical procedure for Stage 3 osteonecrosis of the femoral head (ONFH) remains controversial. This study aimed to evaluate and compare postoperative quality of life (QOL) in patients who underwent total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) for ONFH based on comprehensive and disease-specific scales using patient-directed questionnaires. Methods: We included 54 of 66 patients who underwent artificial joint replacement for ONFH more than 1 year ago at our hospital between April 2013 and September 2020. THA was performed for ONFH Stage 4 and BHA for Stage 3 or below. The mean postoperative observation period in the THA and BHA groups was 3.9 and 3.7 years, respectively. The Short-Form 6-Dimension measure was used to calculate utility values. Results: No significant differences in questionnaire results regarding disease-specific or comprehensive measures were observed after arthroplasty for ONFH between the THA and BHA groups. The utility values were 0.60 and 0.58 in the THA and BHA groups, respectively. Conclusion: The postoperative QOL was similar between patients who underwent THA for Stage 4 ONFH and BHA for Stage 3 ONFH. Therefore, THA or BHA can be performed on patients with ONFH after considering age, stage classification, and previous medical conditions.

Long-Term Outcomes of Cementless Bipolar Hemiarthroplasty in Young Patients With Osteonecrosis of the Femoral Head: The Impact of Implant Improvements and Preoperative Stage.

Introduction Advancements in bipolar hemiarthroplasty (BHA) implants in the mid-1990s contributed to favorable short-term outcomes for osteonecrosis of the femoral head (ONFH), particularly in cases without acetabular cartilage lesions. Nevertheless, long-term results remain unclear. In this study, we investigated (i) the impact of new-generation BHA implants and (ii) the effect of the preoperative stage on long-term outcomes in young patients with ONFH. Methods The records of consecutive patients with ONFH who underwent cementless BHA were retrospectively reviewed. Patients aged ≥60 years, with <10 years of follow-up, or who underwent acetabular reaming during surgery were excluded. Radiographical and clinical outcomes of patients who received first-generation BHAs and new-generation BHAs (developed after 1998) were compared by stratifying based on preoperative stage 2/3A and 3B/4, according to the Japanese Investigation Committee classification. Results Overall, 50 hips from 39 patients (mean age: 44.6 years; 64% male) with an average follow-up of 18.6 years were included. The frequency of advanced-stage patients was significantly higher in the first-generation BHA group than in the new-generation group. Regarding postoperative outcomes, the first-generation BHA group had higher acetabular erosion grades (p<0.001) and more femoral component loosening than those in the new-generation group (p<0.001). Revisions were performed in eight hips (seven in the first-generation and one in the new-generation BHA groups, p<0.001). In the new-generation BHA group, there were no significant differences in patient background between stage 2/3A and 3B/4 groups, and only one case in the stage 3B/4 group required revision. In the new-generation group, the grade of acetabular erosion was significantly higher for stage 3B/4 than stage 2/3A (p<0.001); other radiographical and clinical outcomes did not differ significantly between stages. Conclusion New-generation BHAs have significantly better implant survival rates for early-stage ONFH than those of first-generation BHAs. These findings indicate that BHA is an acceptable treatment option for early-stage ONFH in young patients.

Comparison of functional outcome between Bipolar Hemiarthroplasty and total Hip Arthroplasty for displaced femoral neck fractures in elderly patients

Objectives: The intention of this study to compare functional outcomes between Total Hip Arthroplasty and Bipolar Hemi Arthroplasty for displaced femoral neck fracture after 3 months and 1 year from injury in elderly patients. Methods: Prospectively 43 patients were enrolled in this study, ages more than 60, twenty-four of them managed by Total Hip Arthroplasty, and 19 were managed by Bipolar Hemi Arthroplasty. These patients were followed up postoperatively for one year, at (3 and 12 months), to compare functional outcomes using Haris Hip Score. Results: Duration of operation was significantly higher in Total Hip Arthroplasty (98.54 min) versus (62.63 min) in the Bipolar Hemi Arthroplasty group, and intra-operative blood loss also considerably higher in Total Hip Arthroplasty (322.5 ml) than Bipolar Hemi Arthroplasty (178.42 ml). Regarding complications, there is no difference between the two groups; however, the incidence of mortality higher in the Bipolar Hemi Arthroplasty population. Average Haris Hip Score, pain and the motion were significantly better after three months and one-year follow-up in the Total Hip Arthroplasty group. The function was nearly the same at both groups after three months but after one-year of follow-up function significantly better (p-value &lt;0.5) in the Total Hip Arthroplasty patients.Conclusion: Total Hip Arthroplasty provides better functional outcomes after three months and one year of follow-up than Bipolar Hemi Arthroplasty when used to manage femoral neck fracture for active old age patients. Bipolar Hemi Arthroplasty may be suitable for older inactive patients with narrow life expectancy with multiple comorbiditie

Complication Rates and Survival of Nonagenarians after Hip Hemiarthroplasty versus Proximal Femoral Nail Antirotation for Intertrochanteric Fractures: A 15-Year Retrospective Cohort Study of 113 Cases.

Intertrochanteric fracture is a very common but serious type of hip fracture in nonagenarians. The surgical treatment remains a significant challenge for orthopedists. The objective of this study was to investigate postoperative complications and survival outcomes compared between bipolar hemiarthroplasty (HA) and proximal femoral nail anti-rotation (PFNA) in nonagenarians with intertrochanteric fractures, and to evaluate the efficacy and safety of the two surgical procedures in this patient population. A total of 113 consecutive nonagenarians who underwent bipolar HA or PFNA for the treatment of intertrochanteric fractures from January 2006 to August 2021 were retrospectively studied in the current paper. There were 34 males and 79 females, with a mean age of 92.2 years (range 90-101 years) at the time of operation. The average duration of follow-up was 29.7 months (range 1-120 months). The full cohort was divided into bipolar HA (77 cases) and PFNA (36 cases) groups. Damage control orthopedics was used to determine the optimal surgery time and assist in perioperative management. A restrictive blood transfusion strategy was employed, along with appropriate adjustments under multidisciplinary assessment, throughout the perioperative period. Perioperative clinical information and prognostic data were analyzed. Kaplan-Meier survival curves were used for survival analysis, and landmark analysis divided the entire follow-up period into 1-12 months (short-term), 13-42 months (medium-term) and 43-120 months (long-term) according to the configurations of Kaplan-Meier survival curves. Both groups had similar general variables except for the proportion of high adjusted Charlson comorbidity index (aCCI) (≥6 points) (6.5% in bipolar HA group and 22.2% in PFNA group, p = 0.024). Intraoperative blood loss and transfusion requirements were greater, and the intraoperative transfusion rates were higher in the bipolar HA group compared to the PFNA group (all p < 0.05). The complications rates, 1- to 60-month cumulative all-cause mortality, postoperative optimal Harris hip score (HHS), and Barthel index (BI) presented no significant difference between the two groups (all p > 0.05). Both groups had similar overall survival curves (p = 0.37). However, landmark analysis revealed that bipolar HA group exhibited higher survival rates in medium-term (p = 0.01), while similar survival rates were observed in the short- and long-term post-operation periods (both p > 0.05). Cox regression with survival-time-dependent covariate calculated the hazard ratio (HR) of bipolar HA was 0.41 in medium-term (p = 0.039). Bipolar HA is equally effective and reliable as PFNA for treating intertrochanteric fractures in nonagenarians. Despite resulting in more intraoperative blood loss and transfusions, bipolar HA therapy is associated with a higher medium-term survival rate compared to PFNA treatment. The application of damage control orthopedics and precise perioperative patient blood management could contribute to the positive clinical outcomes observed in this patient population.

PROSPECTIVE STUDY OF THE FUNCTIONAL OUTCOME OF BIPOLAR HEMIARTHROPLASTY VERSUS TOTAL HIP REPLACEMENT IN ELDERLY PATIENTS WITH FRACTURE OF THE NECK OF FEMUR BY USING HARRIS HIP SCORE

Objectives: Prospectively study of the functional outcome of bipolar hemiarthroplasty (BHA) versus total hip replacement in elderly patients with fracture of the neck of the femur using Harris Hip Score (HHS). Methods: This prospective study was conducted in January 2020, in the Department of Orthopedics and Trauma Centre in J.A. Group of Hospitals, Gwalior (M.P.). 30 patients based on inclusion criteria, Garden type 3 and 4 intracapsular femoral neck fractures in the age group of 60 years and above, with independent ambulation before the injury and requirement of high functional demand activity to be treated with either BHA or THR. Functional assessment was made using HHSs at 14 day, 3 month, and 6 month, post-operatively. Results: This study shows the advantage of total hip arthroplasty (THA) in the recovery of hip function early. Six months after surgery, the Harris score of the THA group was higher than that of BHA group, and the excellent and good score in the THA group was also significantly higher than that in BHA group (p&lt;0.001). Conclusion: THA compared to BHA gives a better functional outcome as evaluated by HHS at the end of 6 months in elderly patients with fracture of the neck of femur by using HHS.

Lactate dehydrogenase (LDH) and C-reactive protein (CRP) as a potential prognostic factor in metastatic bone disease (MBD) of proximal femur based on Harris hip score (HHS) underwent cephalomedullary nailing and bipolar hemiarthroplasty

Introduction: Pathological fractures in the proximal femur are common, often caused by metastatic bone disease (MBD). Treatment options include resection, reconstruction, or fixation. This study explores the prognostic value of C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels in the Harris Hip Score (HHS) for patients with pathological fractures due to MBD. Methods: Forty patients with pathological fractures were divided into cephalomedullary nail (CM) and bipolar hemiarthroplasty (BHA) groups. CRP and LDH levels were measured. The correlation between CRP, LDH, and HHS was assessed using Pearson's and Spearman's correlation. Multiple linear regression was used to predict HHS from CRP and LDH. Results: The mean age of patients was 59 years, with 95% having poor HHS. CRP and LDH levels were significantly correlated with HHS (CRP: r = -0.47, p = 0.002; LDH: r = 0.59, p &lt;0.001). Multiple linear regression showed CRP and LDH as predictors of HHS (R² = 0.36, p &lt; 0.001), with the fitted model: "HHS = 95.76 - 0.317*(CRP) - 0.232*(LDH)". Elevated CRP and LDH levels indicate ongoing inflammation and cellular stress, potentially hindering recovery and impacting HHS. CRP's association with adverse prognoses in various cancers is highlighted. LDH's role in cellular stress and metabolism is emphasized. Combining CRP and LDH evaluations enhances the prognostic assessment of MBD and HHS outcomes. Conclusion: CRP and LDH levels significantly correlate with HHS in patients with MBD-related pathological fractures. Higher levels of CRP and LDH indicate worse functional outcomes. Evaluating these biomarkers aids in assessing disease severity and treatment effectiveness, assisting in informed clinical decisions. This study sheds light on the prognostic potential of CRP and LDH in the context of metastatic bone disease and its impact on hip function and recovery.

Comparison Between Bipolar Hemiarthroplasty and Total Hip Arthroplasty in Cases of Neck Femur Fracture

Background: Femoral neck fractures pose a significant burden to the healthcare system in developed and developing countries. Objective: To compare between total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) in patients with the neck of femur fracture. Materials and methods: This was a retrospective review of patients files who underwent total hip arthroplasty and bipolar hemiarthroplasty for femur neck fractures between January 2016 to December 2018. Fisher's exact test was used to detect differences between categorical variables. Significance was accepted at the p&lt;0.05 level. Results: The females were predominant (57.1%). The group BHA were (52.4%) and the group THA were (47.6%). The mean age of BHA group was 79.4 ± 5.1 years and of THA group was 71.4 ±3.0 years (p=0.000). Comorbidities were found more in the group of BHA, (p &gt; 0.05). Level of activity was high in the group of THA (28.6%), (p = 0.001). Post-operative waking after one day was found among (38.8%) of the group THA, and in the group BHA was in (4.8%) patients, (p = 0.002). Seven (33.4%) of the group THA used the walking aids for 2 months, while the group BHA used the walking aids during the 5 months, (p = 0.008). The operative time of the group THA was 2 hours, and of the group BHA was one hour, (p = 0.000). Deep vein thrombosis, superficial infection and deep infection found only among patients of group BHA (9.6%), (9.6%), and (4.8%) respectively. Dislocation was found in (4.8%) patient of the group THA. Conclusion: THA and BHA are the preferred treatment options for FNF, as they lead to satisfactory function and performance in the elderly. Further studies with large number of study sample are in need. Keywords: Neck femur fracture, comparison, bipolar hemiarthroplasty, total hip arthroplasty

Functional results of patients with femoral intertrochanteric fractures who underwent surgery of proximal femoral nail or bipolar hemiarthroplasty – a comparative study

ABSTRACT Purpose: In this study, the functional results of patients with femoral intertrochanteric fractures who underwent surgery were compared with their clinical features in terms of proximal femoral nail ( PFN ) and bipolar hemiarthroplasty ( BPH ). Methods: PFN (Group 1) was implanted in 40 of 89 patients (44 female, 45 male) aged between 51-80 (mean 68,16 ± 6,78) whereas BPH (Group 2) was used with 49 patients. Age, gender, fracture mechanism, additional disease, Body mass index (BMI), Albumin level, Hemoglobin (Hb) decrease level, T-score, American Society of Anesthesiologists (ASA) classification, type of anesthesia, surgery type, operation time, hospital stay and full weight-bearing time, the scores of Harris Hip Function (HHS), the social function of Jensen (JSF), Parker-Palmer mobility (PPMS) in preoperative and postoperative periods, and postoperative complications were all recorded. Results: In group 1; patients were younger, operation time was 46.78 ± 5.29 minutes and hospital stay was 2.48±0.75 days, which were shorter compared with group 2. For group 1, most surgery types were closed, T-score was -2.49±0.59 and better, the time of full weight-bearing was 3.48±0.78 months, Hb decrease was 1.17±0.37 and less, and Albumin level was 3.11±0.4 g/dL and higher compared to group 2 (p&lt;0.05). HHS was better in the BPH group at the sixth month (p&lt;0.05). In group 1, the 12th, and 24th months scores of JSF were better, PPMS was higher in all evaluations (p&lt;0.05). Operation time, ASA, T-score, albumin correlate with functional scores, while BMI and Hb did not. Conclusion: Many factors are important for progressing patients with intertrochanteric femur fractures toward a functional level. Considering these parameters in patients with femoral intertrochanteric fracture , PFN or BPH can both be used for treatment according to the surgeon's preference.

Prospective study of management of unstable intertrochantric femur fractures in elderly: hemiarthroplasty vs. osteosynthesis by proximal femoral nail

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A prospective study was done to compare the outcomes of management of unstable intertrochantric femur fractures in elderly by hemiarthroplasty and osteosynthesis by proximal femoral nail.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was an interventional prospective study.&lt;strong&gt; &lt;/strong&gt;The study was carried out over 3 years from 2019 to 2022 at PCMC’s PGI YCMH, Pimpri, Pune, Maharashtra, India&lt;strong&gt;. &lt;/strong&gt;The study was carried out over 3 years from 2019 to 2022;50 Patients were randomly divided into two groups; Group A (unstable intertrochanteric femur fracture patients treated by bipolar hemi-arthroplasty) and Group B (unstable intertrochanteric femur fracture patients treated by proximal femoral nailing) with 25 patients in each group. Outcomes were evaluated based on functional outcomes, mean surgical time, mean blood loss during surgery, post-operative length of stay, post-operative complications. Harris hip Score was used to assess clinical functional outcomes.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The PFN group showed a better Harris Hip score at 1, 3, and 6 months follow ups.&lt;strong&gt; &lt;/strong&gt;Mean surgical time was more in bipolar hemiarthroplasty group. Mean blood loss during surgery was more in bipolar hemiarthroplasty group. Post-operative length of stay was more in bipolar hemiarthroplasty group. Post-operative complications like infections, limb length discrepencies were more in bipolar hemiarthroplasty group, whereas 2 implant failures occurred in PFN group compared to a single one in bipolar hemiarthroplasty group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both PFN and bipolar-hemiarthroplasty appear to produce satisfactory outcomes in surgically treated unstable IT fractures, bipolar-hemiarthroplasty has the advantages of early mobilization and early weight bearing, no risk of non-union but PFN group is superior when it comes to functional outcomes, mean surgical time, Mean blood loss during surgery, post-operative length of stay, post-operative complications.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Prognostic factors between the proximal femoral nail and bipolar hemiarthroplasty in femoral intertrochanteric fractures

Aim: In the treatment of intertrochanteric femur fractures, proximal femoral nail (PFN), and bipolar hemiarthroplasty (BPH) are widely used. This study aimed to compare these two types of implants depending on risk factors regarding patients. &#x0D; Material and Method: PFN (Group 1) was applied to 40 of the 89 patients (44 female, 45 male) aged between 51-80 (mean 68.16±6.78) and BPH (Group 2) was applied to 49 of them. Age, gender, fracture side, fracture mechanism, additional disease, Body mass index (BMI), Albumin level, Hemoglobin (Hb) decrease level, T-score, American Society of Anesthesiologists (ASA) classification, type of anesthesia, surgery type, operation time, hospital stay and full weight-bearing time, Harris Hip Score (HHS) in preoperative and postoperative periods, classification of intertrochanter fracture according to the AO Foundation and Orthopedic Trauma Association (AO/OTA), postoperative complications were recorded.&#x0D; Results: Group 1 was younger with a mean age of 64.55±6.23 years compared to Group 2 (p 0.05). In group 1, operation time was 46.78±5.29 minutes and hospital stay was 2.48±0.75 days, which was shorter, most surgery types were closed, T-score was -2.49±0.59 and better, the time of full weight-bearing was 3.48±0.78 months, Hb decrease was 1.17±0.37 g/dL and less, Albumin level was 3.11±0.4 g/dL and higher (p

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.

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&amp;lt;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.

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.

Hemiarthroplasty vs. tripolar total hip arthroplasty in the treatment of displaced femoral neck fractures in old-age patients

Background Displaced femoral neck fractures (DFNFs) are increasingly common in elderly patients. Hip arthroplasty, the recommended treatment of DFNF, consists of the total hip arthroplasty (THA) and hemiarthroplasty (HA). THA is superior to HA in younger patients. However, there are concerns whether the more substantial surgical trauma and higher dislocation rate would trade off the advantages of THA due to frailty and lower physical demands in the elderly over 75 years. Objective This study was designed to compare the clinical score, dislocation rate, and functional outcome between the dual mobility total hip replacement and the bipolar hemiarthroplasty (BHA) in the treatment of FNFs and which of them is more successful. Patients and methods A comparative randomized prospective study was conducted on 50 patients with DFNFs. All cases were operated upon in Helwan University Hospitals, divided them into two equal groups: the first group was treated by total hip replacement with a dual mobility cup (DMC) and the second group was treated by BHA. Full analysis of history detailed examination and primarily samples are taken during the period study from February 2020 to April 2021. Results There is a statistically significant improvement in modified Harris hip score (MHHS) in the last follow-up at 9 months later in favor to DMC group compared with BHA group (P<0.001). The postoperative MHHS in the last follow-up of DMC ranged from 68 to 92 with the mean of 85.96±5.47, whereas in BHA group, ranged from 60 to 89 with the mean of 78.04±8.40. Conclusion THA may be a preferred management option for active elderly patients over 75 years, which can provide superior hip function and life quality with acceptable risks. Strict management should be followed to prevent dislocation after a THA, especially within the first 6 months.

A comparative study of functional outcome of bipolar hemiarthroplasty versus total hip arthroplasty in fracture neck of femur in elderly patients

Introduction: Fractures of the femoral neck are an international public health problem mainly occurring in elderly patients and resulting in high mortality. With the aging population, the incidence of these fractures is steadily increasing. Treatment choices for the neck of femur fractures in the elderly age group includes hemiarthroplasty (HA) and total hip replacement (THR). The treatment option must be decided by the type of fracture, condition of the patient, functional demands, medical and mental ability to cope with the surgery. This study compares bipolar hemiarthroplasty (BH) and total hip replacement (THR) in elderly patients with neck of femur fracture. Aim: To evaluate the functional outcome, complications and mortality of Bipolar Hemiarthroplasty and Total Hip Arthroplasty as a treatment modality in neck of femur fracture patients. Materials and Methods: A prospective study was conducted in the Department of Orthopaedics, Rajah Muthiah medical college, in which 30 Patients of age 55 years and above who underwent hip arthroplasty (BHA or THA) for neck of femur fracture with follow up were included. Patients were separated into two groups by random allocation. Patients of group 1 (15 patients) were treated by bipolar hemiarthroplasty and group 2 (15 patients) by total hip arthroplasty. Both groups were followed up post-operatively for one year, at 6, 12 months, for surgical complications including dislocation, fracture, surgical site infection, and, one-year mortality and functional outcome using Modified Harris Hip Score. Results: Modified Harris Hip Score was higher in Total hip arthroplasty group compared to bipolar hemiarthroplasty group, pain was similar in both groups post operatively. Gait and range of motion were higher in the Total Hip Arthroplasty group, no significant difference was seen in mortality and post-operative complications between the two groups. Conclusion: In our study, we conclude that Total hip arthroplasty is ideal to treat femoral neck fractures in elderly patients with arthritic changes and has a lower risk of re operation when compared to Bipolar hemiarthroplasty, however bipolar hemiarthroplasty has a better outcome in cases of acute femoral neck fractures, based on our study.

Analysis of risk factors affecting mortality in elderly patients operated on for hip fractures: A retrospective comparative study.

The aims of this study were (1) to investigate the effects of different demographic and perioperative modalities on mortality rates and (2) to compare mortality rates between different implants in elderly patients operated on for hip fractures. In this retrospective study, a total of 314 patients who were operated on for hip fractures were included study. Patients were then divided into four groups based in their implant types: long-stem cementless bipolar hemiarthroplasty (n = 124; 102 female, 22 male; mean age = 84.2 ± 6.4 years), standard-stem cementless bipolar hemiarthroplasty (n = 74; 48 female, 26 male; mean age = 83.5 ± 6.9 years), antegrade intertrochanteric nail (n = 61; 35 female, 26 male; mean age = 78.5 ± 6.8 years), and total hip arthroplasty (n = 55; 34 female, 21 male; mean age = 72.5 ± 4.3 years). Data including gender, age, duration from injury to surgery, American Society of Anesthesiologists (ASA) score, comorbidities, use of antiplatelet agents, Barthel Index of Activities of Daily Living, type of anesthesia, operation time, preoperative hemoglobin values, blood transfusions given, duration of hospital stay, complications, and type of fracture were recorded. Overall, the mean follow-up was 36.5 (range = 0 - 107) months. The overall mortality rate was 53.2%. The median survival duration was 44.2 ± 5 months (range = 34.3 - 54). Survival rates were found significantly different among the groups (P = 0.001). In the first three years postoperatively, the mortality rate was higher in the standard-stem bipolar hemiarthroplasty group, but in the long-term follow-up, the long-stem bipolar hemiarthroplasty group exhibited the higher mortality rates. It was observed that some parameters had statistically significant effects on the mortality rates. Male gender, higher age, lower hemoglobin values, increased number of blood transfusions, ASA scores ≥3, the existence of ≥ 3 comorbidities were found as main predictors of increased mortality rates. The results of this study have shown that age, gender, preoperative hemoglobin levels, ASA scores, and comorbidities are significant factors affecting mortality in elderly patients operated on for hip fractures. Long-stem cementless bipolar hemiarthroplasty appears to show similar rates of mortality with standard-stem cementless bipolar hemiarthroplasty. Level III, Therapeutic Study.

A comparative study of functional outcome of proximal femoral nailing and bipolar hemiarthroplasty in unstable basicervical fracture neck of femur in age >45 years

Background: A basicervical femoral neck fracture, which is located at the junction between the femoral neck and intertrochanteric region, is a rare type of fracture. (1) Despite several randomized trials and comparative studies treatment of unstable basicervical fractures in elderly patients is still controversial, which we want to investigate. Methods: A prospective cohort analysis of 44 patients, of which 22 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2018 till July 2021 was done. Primary outcome was assessed in both groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary outcome measures were intraoperative blood loss, surgical time, functional outcome, range of motion limb length discrepancy at final follow up. All complications were noted at follow up.Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 79.81 for BPA and 73.18 for PFN (p-value = 0.001) and at 1 year of follow up was 88.55 for BPA and 79.03 for PFN (p-value = 0.001). Statistically significant differences were found between BPA and PFN groups with reference to intraoperative blood loss, surgical time, functional outcome, range of motion, limb length discrepancy at final follow up.Conclusion: The bipolar hemiarthroplasty group had fewer complications and earlier mobilization with better Harris hip score at all follow ups, which indicate bipolar hemiarthroplasty is a better option in the treatment of unstable basicervical fractures in elderly patients.

Dual mobility total hip arthroplasty in the treatment of femoral neck fractures.

To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z -4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z -3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z -4.2). While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457-1466.

Dual mobility total hip arthroplasty in the treatment of femoral neck fractures

To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z -4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z -3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z -4.2). While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA.