Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up.
OBJECTIVE
This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis.


METHODS
A retrospective review of prospectively collected data.


METHODS
Hospital-based tertiary care orthopaedic trauma practice.


METHODS
Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement.


METHODS
One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis.


METHODS
The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up.


RESULTS
The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups.


CONCLUSIONS
Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use.
Ong
Bernard C
BC
Geriatric Hip Fracture Program, Department of Orthopedics, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, U.S.A.
Maurer
Stephen G
SG
Aharonoff
Gina B
GB
Zuckerman
Joseph D
JD
Koval
Kenneth J
KJ
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011336:Probability; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome