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Unipolar Versus Bipolar Hip Hemiarthroplasty in the Treatment of Femoral Neck Fractures in the Elderly

Authors: Ali A. Ali --- Saad M. Rashed --- Mushtaq T. Hussien
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 475-485
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Hip fractures are associated with high morbidity and mortality, which require a treatment plan that ensures a good outcome with minimal complications. Different treatment modalities and arthroplasty prosthesis are available and widely used.OBJECTIVE: The aim of this study was to compare the short outcome of surgical treatment of femoral neck fractures in elderly using unipolar and bipolar hip hemiarthroplasty.PATIENTS AND METHODS: Thirty four patients with intracapsular femoral neck fractures ranging from Garden’s class II to class IV were enrolled in the study for surgical intervention using either unipolar hemiarthroplasty (Group A: 14females, 6 males) or bipolar hemiarthroplasty (Group B: 10 females, 4 males). Patients were followed up for up to 2 years by Harris Hip Score to assess the outcome of the surgery. RESULTS: The average hip score for patients per group over the whole follow-up period showed better results in group B than in group A. Average score results were higher in all grades among group B patients. However, the difference from scores of group A patients was statistically insignificant (p>0.05). Patients of both groups had a negative correlation of age to score outcome regardless of sex and grade of fracture. In group A patients, score points for pain, stiffness, range of motion and support/locomotion were all higher during the first six months of follow up. The scores started to decline gradually after 18 months towards the end of the follow up period. In group B patients, the score points for the same parameters were all significantly lower than Group A patients during the first 3-6 months of follow up but started to increase to significantly higher levels towards the end of the follow up period.CONCLUSION: The short-term advantages of unipolar hemiarthroplasty may outweigh its long-term complications in elderly patients with limited daily activities and/or associated serious medical illnesses. In younger age patients with more ambulatory activities and greater life expectancy, bipolar hemiarthroplasty offers a better solution.

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