title: Bipolar or unipolar hemiarthroplasty after femoral neck fracture in the geriatric population.
abstract: BACKGROUND
  The choice of prosthesis in hemiarthroplasty is controversial for geriatric patients after femoral neck fracture. We hypothesised that selection criteria for unipolar or bipolar prostheses could be constructed based on factors affecting mortality.
  
  
  OBJECTIVE
  THE AIMS OF THIS RETROSPECTIVE STUDY WERE: (1) to determine the factors affecting mortality of femoral neck fracture patients ≥65 years of age; (2) to compare patient mortality rates, radiological findings, and functional outcomes according to prosthesis type (unipolar or bipolar); and (3) to evaluate the persistence of inner bearing mobility of bipolar prostheses.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  In total, 144 patients operated for hemiarthroplasty and aged ≥65 were included. We classified the patients into either unipolar or bipolar prosthesis groups. To reveal factors that affected mortality, age, sex, delay in surgery, and American Society of Anesthesiologists score were obtained from folders. Barthel Daily Living, Harris hip, and acetabular erosion scores were calculated and bipolar head movement was analysed for live patients.
  
  
  RESULTS
  One-year mortality was 31.94%. Age ≥75 (p=0.029), male sex (p=0.048), and delay in surgery ≥6 (p=0.004) were the patient characteristics that were related to increased mortality. There were no significant differences in sex, age, American Society of Anesthesiologists score, delay in surgery, mortality, or Barthel, Harris, acetabulum scores between the two groups. Twenty patients from each group were admitted for last follow-up. Bipolar head movement was preserved for 33.3% of patients. They were inactive patients with low Barthel and Harris scores.
  
  
  CONCLUSIONS
  Although bipolar head movement was preserved in inactive patients, we suppose that this conferred no advantage to these patients, who could hardly walk. In this study, male patients, those aged ≥75 years, and those operated at ≥6 days had an increased risk of mortality. Also, although not significant in multivariate analysis, high American Society of Anesthesiologists score (≥3) was related to increased mortality. Considering that one of three patients died during the first postoperative year, we think that these patients should be operated as soon as possible, and expensive bipolar prostheses must be used selectively in regard to patient characteristics.
authors.affiliation: Department of Orthopaedics and Traumatology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
authors.forename: Egemen
authors.initials: E
authors.lastname: Ayhan
authors.affiliation: Department of Orthopaedics and Traumatology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Kesmezacar
authors.affiliation: Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ozgür
authors.initials: O
authors.lastname: Karaman
authors.affiliation: Department of Orthopaedics and Traumatology, Çorlu Public Hospital, Tekirdağ, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Sahin
authors.affiliation: Department of Orthopaedics and Traumatology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
authors.forename: Nail
authors.initials: N
authors.lastname: Kır
keywords: Femoral neck fracture; hemiarthroplasty; mortality