Cemented bipolar hemiarthroplasty versus total hip arthroplasty in femoral neck fracture patients. Results from Lithuanian Arthroplasty Register

Abstract

Introduction Elderly patients with displaced femoral neck fractures (FNF) are usually operated with arthroplasty but with various combinations of implants and surgical approaches. Thus, the optimal treatment is still controversial. We aimed to compare the results between the cemented bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) patients operated for FNF regarding revision rate at 1-year postoperatively. Materials and Methods The data were derived from the Lithuanian Arthroplasty Register. A total of 4,612 FNF patients were registered during 2011-2016. We included patients operated with cemented bipolar HA and compared them to the most frequently used cemented THA. For survival analysis, we used both revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age groups, gender, surgical approaches and arthroplasty groups). Results There were 1,177 bipolar HA and 514 THA included in our study. 26 (2.2%) revisions had occurred among the bipolar HA’s as compared to 25 (4.9%) among the THA’s one year after surgery. The main reason for revision was dislocation. The unadjusted cumulative revision rate for any reason of revision at 1 year after surgery was 2,4% for the bipolar HA group and 5.1% for the THA group (p=0.0054). Cox regression showed that the use of bipolar HA, anterolateral approach and younger age groups had lower risk of revision for all reasons. Conclusion Bipolar HA and anterolateral approach had a significantly lower overall 1-year risk of revision in femoral neck fracture patients.