Hip Pelvis.  2019 Jun;31(2):63-74. 10.5371/hp.2019.31.2.63.

Clinical Outcomes of Bipolar Hemiarthroplasty versus Total Hip Arthroplasty: Assessing the Potential Impact of Cement Use and Pre-Injury Activity Levels in Elderly Patients with Femoral Neck Fractures

• Yoo JI
• Cha YH
• Kim JT
• Park CH

• KMID: 2448024
• DOI: http://doi.org/10.5371/hp.2019.31.2.63

Abstract

PURPOSE
This study was performed to analyze the potential impact of cement use and favorable pre-injury activity on clinical outcomes of bipolar hemiarthroplasty (BHA) compared with total hip arthroplasty (THA) in elderly patients with femoral neck fractures.
MATERIALS AND METHODS
Systematic review and meta-analysis of 12 clinical studies (5 randomized controlled trials and 7 comparative studies). Subgroup analysis was performed based on type of fixation method (cemented vs. cementless) and in the patient with independent ambulation, respectively.
RESULTS
A significantly higher dislocation rate was observed in patients treated with THA compared with those treated with BHA in individuals capable of independent ambulation before injury (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05-0.62; P=0.05, Z=1.98). Also, the dislocation rate was significantly higher in patients treated with cemented THA compared with those treated with cemented BHA (OR, 0.18; 95% CI, 0.05-0.62; P=0.006, Z=2.73). EQ-5D was significantly higher in those treated with cemented THA compared with patients treated with cemented BHA. Lastly, HHS was significantly higher in patients treated with cementless THA compared with those treated with cementless BHA.
CONCLUSION
An increase in the dislocation rate was observed when THA was performed in elderly patients with femoral neck fracture and who were pre-injury independent walkers. In addition, cemented THA was associated with a higher dislocation rate compared with cemented BHA. However, the dislocation rate in those treated with cementless THA were similar to patients treated with cementless BHA. With regards to functional score, THA was superior to BHA in both cementless and cemented fixation.

Keyword

Arthroplasty; Hip replacement arthroplasty; Bipolar hemiarthroplasty; Femoral neck fractures

MeSH Terms

Aged*
Arthroplasty
Arthroplasty, Replacement, Hip*
Butylated Hydroxyanisole
Dislocations
Femoral Neck Fractures*
Femur Neck*
Hemiarthroplasty*
Humans
Methods
Walkers
Walking
Butylated Hydroxyanisole

Figure

• 

  Fig. 1 Evaluation of risk of bias.

• 

  Fig. 2 PRISMA (Preferred Reporting Items for Systematic Reviews) flow diagram representing the details of the process of selecting relevant clinical studies.RCT: randomized controlled trial.

• 

  Fig. 3 Forest plot of the one-year mortality rates comparing the experimental (THA) and control (BHA) groups in those treated with cemented prosthesis.THA: total hip arthroplasty, BHA: bipolar hemiarthroplasty, CI: confidence interval, M-H: Mantal-Haenszel.

• 

  Fig. 4 (A) Forest plot of the dislocation rates comparing the experimental (THA) and control (BHA) groups in those treated with cemented prosthesis. (B) Forest plot of reoperation rates comparing the THA and BHA groups in those treated with a cemented prosthesis. (C) Forest plot of infection rates comparing the THA and BHA groups in those treated with a cemented prosthesis.THA: total hip arthroplasty, BHA: bipolar hemiarthroplasty, CI: confidence interval, M-H: Mantal-Haenszel.

• 

  Fig. 5 (A) Forest plot of Harris hip score comparing the experimental (THA) and control (BHA) groups in those treated with a cemented prosthesis. (B) Forest plot of EQ-5D comparing the THA and BHA groups in those treated with a cemented prosthesis.THA: total hip arthroplasty, BHA: bipolar hemiarthroplasty, SD: standard deviation, CI: confidence interval.

• 

  Fig. 6 (A) Forest plot of dislocation rates comparing the experimental (THA) and control (BHA) groups in those treated with cementless prosthesis. (B) Forest plot of reoperation rates comparing the THA and BHA groups in those treated with a cementless prosthesis.THA: total hip arthroplasty, BHA: bipolar hemiarthroplasty, CI: confidence interval, M-H: Mantal-Haenszel.

• 

  Fig. 7 Forest plot of Harris hip scores comparing the experimental (THA) and control (BHA) groups in those treated with a cementless prosthesis.THA: total hip arthroplasty, BHA: bipolar hemiarthroplasty, SD: standard deviation, CI: confidence interval.

• 

  Fig. 8 (A) Forest plot of dislocation rates comparing the experimental (THA) and control (BHA) groups in a subgroup analysis including independent walkers. (B) Forest plot of reoperation rates comparing the THA and BHA groups in a subgroup analysis including independent walkers. (C) Forest plot of infection rates comparing the THA and BHA groups in a subgroup analysis including independent walkers.THA: total hip arthroplasty, BHA: bipolar hemiarthroplasty, CI: confidence interval, M-H: Mantal-Haenszel.

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