Bipolar Hemiarthroplasty For Displaced Intracapsular Fractures Of The Femoral Neck In Elderly Patients

Objective There is continuing controversy about whether bipolar hemiarthroplasty or total hip arthroplasty should be used for the management of displaced intracapsular fractures of the femoral neck in elderly patients (>or=80years).In this study,indications for and advantages of this endoprosthesis are evaluated.We sought to assess the results of this procedure at our hospital after a average duration of follow-up of 8.5 years.Methods We retrospectively reviewed a consecutive series of 69 elderly patients 69 hips(>or=80years) who underwent primary bipolar hemiarthroplasty for the treatment of acute femoral neck fractures with a cementless femoral component for the last 4 years between 1/21/1998 and 5/24/2002.Of the original cohort of 69 patients,31 patients 31 hips were available for clinical and radiographic review at a mean of 8.5 years postoperatively while 18 patients 18 hips were available only for clinical review by telephone.At the time of latest follow-up,self-administered Harris hip questionnaires and ADL,EQ-5D index were used to assess pain,mobility,activity level,and overall satisfaction with the procedure.Radiographs and BMD of the operation limb were made to evaluate bipolar shell migration,acetabular wearing, osteolysis,and femoral stem fixation.Results At the time of the latest follow-up,in the group of 69 patients,no dislocation of the prosthesis occurred.Protrusion into the acetabulum,which is a feared complication of classical hemiarthroplasty was not detected.Evidence of acetabular erosion(light to moderate degree) was noted in only 9 patients(13.04%).The endoprost hesis was pain free in nearly all the patients except 5 patients(7.25%) rated the thigh or groin pain as light to moderate who required analgesics on a regular basis.But these cases didnot required to received revisional total hip replacement except 2 cases(2.90%),one patient with persistent pain caused by moderate acetabular erosion verified by X-ray,the other patient complained persistent thigh and groin pain diagnosed as have obvious osteolysis and loosening of the stem and was verified by X-ray and BMD examination.Radiographs were available for 31 hips(including all of the hips with light to moderate pain)after a average duration of follow-up of 8.5 years.After a mean of 8.5 years follow-up,we obtained 47(95.92%) excellent or good results and 2(2.90%) fair results according to the Harris hip-scoring system.Conclusion Bipolar hip hemiarthroplasty is a treatment option in acute displaced intracapsular fractures of the femoral neck in elderly patients(>or=80years).Its main advantages include less stress and strain for the patients than in total hip arthroplasty,and better stability and lower risk of protrusion into the acetabulum than in classical hip hemiarthroplasty.Its simpler implantation also makes the surgical procedure less demanding for both the patient and the surgeon.The key point of the successful operation is the choice of the prosthesis size while the operation skill of surgeons is also very important.