Bipolar hemiarthroplasty may be preferred treatment for elderly patients

Hedbeck CJ. Int Orthop. 2011; doi:10.1007/s00264-011-1213-y.

Despite equivalent 1-year outcomes, the significantly higher incidence of acetabular erosion with unipolar hemiarthroplasty suggests that bipolar hemiarthroplasty may be the preferred treatment, according to a randomized, controlled trial

Carl Johan Hedbeck, MD, of Karolinska Institute, in Stockholm, Sweden, and colleagues randomized 120 patients with an acute displaced femoral neck fracture to receive either unipolar or bipolar hemiarthroplasty. Mean patient age was 86 years. To measure outcome, the investigators used the Harris Hip Score to track hip function, the HRQoL (EQ-5D) and acetabular erosion. They evaluated the patients at 4 and 12 months postoperatively.

The results showed no significant differences in complications between the groups. The HHS scores were equivalent at 4 and 12 months. The HRQoL trended toward better results in the bipolar hemiarthroplasty group at 4 months. At 12 months, 20% of patients in the unipolar group had acetabular erosion vs. 5% in the bipolar group. Furthermore, patients with acetabular erosion tended to have worse hip function and HRQoL scores. HHS scores for patients with erosion were 70.4 compared with 79.3 for those without erosion. EQ-5D scores were 0.48 for the patients with erosion and 0.63 for those without erosion.