Primary Total Hip Arthroplasty Versus Bipolar Hemiarthroplasty for Fracture Neck of Femur in Geriatric Patients: Comparative Functional Outcomes Study

Abstract

Context: The femoral neck fracture has been a great challenge to orthopedic surgeons for a long time. Established surgical options for displaced femoral neck fracture mainly include internal fixation, hemiarthroplasty, and total hip arthroplasty (THA). The optimal treatment choice for elderly patients is still frequently debated. The answer to whether THA is better than bipolar hemiarthroplasty for displaced femoral neck fractures is still uncertain. In elderly patients, hemiarthroplasty is currently the most commonly chosen treatment option for displaced femoral neck fractures, but several recent studies suggest that it may not be the best treatment choice. Many patients undergoing hemiarthroplasty for the treatment of a displaced femoral neck fracture experience discomfort and compromised functional outcomes due to degeneration of the articulating acetabular cartilage. MATERIALS AND METHODS: A total number of 60 patients were selected randomly. The fracture pattern included in study was a fracture neck of the femur. Selection was based on preformed inclusion and exclusion criteria. The functional outcomes and clinical results of the patients were evaluated and graded using the Harris Hip Score. Statistical Analysis Used: SPSS software version 22.0 was used for statistical analysis. Results: In our study, there were 30 (50%) patients who were treated with THA and the remaining 30 (50%) were treated with bipolar hemiarthroplasty. Out of 60 patients, 20 had Garden type III fracture, whereas 40 had Garden type IV fractures. In THA group, the average time of surgery was 94.80 min and with bipolar hemiarthroplasty, the average time of surgery was 72.20 min. Mean intraoperative blood loss in THA group was 518 ml and in the bipolar hemiarthroplasty group, it was 339 ml. In addition, THA group patients had better Harris Hip Scores when compared with the bipolar hemiarthroplasty group. The complication rates were significantly lower in the THA group. Conclusions: The present study showed that THA compared to bipolar hemiarthroplasty gives a better functional outcome as evaluated by Harris Hip Score at the end of 6 months but at the cost of marginally higher blood loss and longer duration of surgery. Furthermore, there is a reduced risk of complication and reoperation rate in THA group. Hence, the findings suggest that THA might be a better choice than bipolar hemiarthroplasty for treating femoral neck fractures in elderly patients preferring a more active lifestyle.

Keywords

• bipolar hemiarthroplasty
• fracture neck of femur
• total hip arthroplasty