Key result
Bipolar hemiarthroplasty demonstrated comparable functional outcomes to total hip replacement at 24 months, with reduced surgical duration (50 vs 119 minutes) and blood loss.
Why the study?
Optimal surgical choice between bipolar hemiarthroplasty and total hip replacement for elderly patients with displaced femoral neck fractures remains an open question.
Does bipolar hemiarthroplasty improve functional outcomes compared to total hip replacement in elderly patients with displaced femoral neck fractures?
RCT (n=30)
Randomized into two groups
No
Does bipolar hemiarthroplasty improve functional outcomes compared to total hip replacement in elderly patients with displaced femoral neck fractures?
Bipolar hemiarthroplasty provides comparable functional outcomes to total hip replacement in elderly patients with displaced femoral neck fractures, with the added benefits of shorter surgical time and reduced blood loss.
Answers are grounded in this paper and cite their sources.
May inform HA vs THR selection in elderly femoral neck fractures; leaves open optimal strategy pending randomized confirmation.
Background: Fractures of the femoral neck present a significant global public health challenge, particularly affecting elderly individuals and leading to high mortality rates. As the aging population continues to grow, the incidence of these fractures is also increasing steadily. When it comes to treating neck of femur fractures in the elderly age group, options include hemiarthroplasty (HA) and total hip replacement (THR). The choice of treatment depends on various factors, including the type of fracture, the patient's overall condition, functional requirements, and their medical and mental capacity to undergo surgery. This study aims to compare the outcomes of bipolar hemiarthroplasty (BHA) and total hip replacement (THR) in elderly patients with neck of femur fractures.Materials and Methods: This was a prospective study of 30 patients of age more than 60 years with closed displaced femoral neck fractures and the patients were randomized into two groups (THR and BHA) of 15 patients each and their outcomes were compared. The study was conducted between May 2022 and December 2022 with a follow up of 2 years.Results: At 24-month follow-up, the total modified Harris Hip scores ranged from 78 to 96.Three (20%) patients in BHA group and 6 (40%) patients in THR group had hip scores from 91 to 100 (excellent), 10 (67%) patients in BHA and nine patients (60%) in THR had hip scores 81–90 (fair) and 2 (13%) patients in BHA group and 1 (7%) patients in THR group were rated 71–80 (good) and none was found in poor category. The mean blood loss during BHA was 235 ml, whereas in THR it was 329 ml. The average duration of surgery was significantly shorter at 50 minutes compared to 119 minutes in the total hip replacement (THR) group. All patients were happy with the procedure and the functional outcome.Conclusion: BHA demonstrates comparable functional outcomes to total hip replacement (THR) when assessed by Modified Harris Hip Score (MHHS). Furthermore, BHA offers several advantages such as significantly reduced blood loss during surgery, shorter surgical duration, and improved cost-effectiveness. Therefore, BHA can be recommended as the primary surgical management option for elderly patients with displaced femoral neck fractures in developing countries.
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Sundar et al. (2023) conducted an RCT in Displaced femoral neck fractures (n=30). Bipolar hemiarthroplasty vs. Total hip replacement was evaluated on Modified Harris Hip Score (MHHS) excellent rating (91-100) at 24 months. Bipolar hemiarthroplasty demonstrated comparable functional outcomes to total hip replacement at 24 months, with reduced surgical duration (50 vs 119 minutes) and blood loss.
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