Should We Use Bipolar Hemiarthroplasty in Patients ≥70 Years Old With a Femoral Neck Fracture? A Review of Literature and Meta-Analysis of Randomized Controlled Trials

  • Philippe Beauchamp-Chalifour
    Affiliations
    Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada

    Centre de recherche FRQS du CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada
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  • Stéphane Pelet
    Affiliations
    Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada

    Department of Orthopedic Surgery, CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada

    Centre de recherche FRQS du CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada
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  • Vincent Belhumeur
    Affiliations
    Centre de recherche FRQS du CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada
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  • Mathieu Angers-Goulet
    Affiliations
    Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada

    Centre de recherche FRQS du CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada
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  • Luc Bédard
    Affiliations
    Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada

    Department of Orthopedic Surgery, CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada

    Centre de recherche FRQS du CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada
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  • Etienne L. Belzile
    Correspondence
    Address correspondence to: Etienne L. Belzile MD, FRCSC, Laval University, CHU de Québec - Hôpital de l'Enfant-Jésus, 1401, 18ème Rue, Québec, Québec G1J 1Z4, Canada.
    Affiliations
    Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada

    Department of Orthopedic Surgery, CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada

    Centre de recherche FRQS du CHU de Québec – Hôpital Enfant-Jésus, Québec, Québec, Canada
    Search for articles by this author
Published:December 13, 2021DOI:https://doi.org/10.1016/j.arth.2021.12.004

      Highlights

      • There seems to be no difference between bipolar and unipolar hemiarthroplasty with regards to hip function scores, Health-PROs and complications at two years.
      • Bipolar hemiarthroplasty might decrease the risk of acetabular erosion.

      Abstract

      Background

      Bipolar (BHA) and unipolar hemiarthroplasties (UHA) are interchangeably used in elderly patients with a displaced femoral neck fracture. We ask if there is a difference between BHA and UHA with regards to hip function, in elderly patients.

      Methods

      Systematic review and meta-analysis was conducted of randomized controlled trials comparing BHA to UHA. The primary outcome was postoperative hip function scores. Secondary outcomes were overall health-related quality of life patient-reported outcomes, acetabular erosion, and postoperative complications. Data sources, last searched on June 1, 2020, were MEDLINE, EMBASE, Cochrane Library, and Web of Science.

      Results

      Fourteen randomized controlled trials were eligible for meta-analysis. There was no difference in hip function scores between BHA and UHA (standardized mean difference 0.32, 95% confidence interval [CI] −0.06 to 0.71, n = 1084, I2 = 87%). Patients with BHA with more than 2-year follow-up had better hip function scores (standardized mean difference 0.68, 95% CI 0.18-1.18, n = 700, I2 = 87%). There was no difference in European Quality of life- five dimensions scores with BHA (mean difference 0.08, 95% CI −0.01 to 0.17, n = 967, I2 = 82%). The use of BHA decreased the risk of acetabular erosion (relative risk 0.38, 95% CI 0.17-0.83, n = 1239, I2 = 0%). There was no difference for revision, mortality, infection, and dislocation (I2 = 0%).

      Conclusion

      There seems to be no difference between BHA and UHA with regards to hip function at 2 years. BHA might decrease the risk of acetabular erosion. There is a need for a large randomized controlled trial with a follow-up >2 years and better measurement tools to assess clinical benefits.

      Level of evidence

      II.

      Keywords

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