Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2015

Open Access 01-12-2015 | Research article

Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials

Authors: Zhiwei Jia, Fan Ding, Yaohong Wu, Wei Li, Haifeng Li, Deli Wang, Qing He, Dike Ruan

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

Login to get access

Abstract

Background

Whether bipolar hemiarthroplasty (BH) for displaced femoral neck fractures has benefit over unipolar hemiarthroplasty (UH) remains controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the relative effects between BH and UH.

Methods

A systematic literature search (up to April, 2014) was conducted to include RCTs comparing BH with UH for displaced femoral neck fractures. Two authors independently assessed methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed.

Results

A total of 10 RCTs including 1,190 patients were indentified. Our results demonstrated that BH was associated with similar or better outcomes in hip function, hip pain, and quality of life while with a higher cost compared with UH. Moreover, there were no significant differences between BH and UH with regard to operation time, blood loss, blood transfusion, hospital stay, mortality, reoperation, dislocation, and complications. BH could significantly decrease the incidence of acetabular erosion at 1 year follow-up compared with UH (RR = 0.24, 95% confidence interval (CI) = 0.06 to 0.89, P = 0.03), but no significant difference was observed at 4 months, 2 years, and 4 years follow-ups.

Conclusions

Based on the current evidence, BH is not superior to UH in terms of surgical information and postoperative results. Despite similar or better clinical outcomes compared with UH, BH with a higher cost could not decrease long-term acetabular erosion rate.
Literature
1.
Bhandari M, Devereaux PJ, Tornetta 3rd P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122–30.CrossRefPubMed
2.
Iorio R, Schwartz B, Macaulay W, Teeney SM, Healy WL, York S. Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons. J Arthroplasty. 2006;21:1124–33.CrossRefPubMed
3.
Crossman PT, Khan RJ, MacDowell A, Gardner AC, Reddy NS, Keene GS. A survey of the treatment of displaced intracapsular femoral neck fractures in the UK. Injury. 2002;33:383–6.CrossRefPubMed
4.
Bhattacharyya T, Koval KJ. Unipolar versus bipolar hemiarthroplasty for femoral neck fractures: is there a difference? J Orthop Trauma. 2009;23:426–7.CrossRefPubMed
5.
Gilbert MS, Capozzi J. Unipolar or bipolar prosthesis for the displaced intracapsular hip fracture? An unanswered question. Clin Orthop Relat Res. 1998;353:81–5.CrossRefPubMed
6.
Lestrange NR. Bipolar arthroplasty for 496 hip fractures. Clin Orthop Relat Res. 1990;251:7–19.PubMed
7.
Wathne RA, Koval KJ, Aharonoff GB, Zuckerman JD, Jones DA. Modular unipolar versus bipolar prosthesis: a prospective evaluation of functional outcome after femoral neck fracture. J Orthop Trauma. 1995;9:298–302.CrossRefPubMed
8.
Kenzora JE, Magaziner J, Hudson J, Hebel JR, Young Y, Hawkes W, et al. Outcome after hemiarthroplasty for femoral neck fractures in the elderly. Clin Orthop Relat Res. 1998;348:51–8.CrossRefPubMed
9.
Lin CC, Huang SC, Ou YK, Liu YC, Tsai CM, Chan HH, et al. Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures. Asian J Surg. 2012;35:62–6.CrossRefPubMed
10.
Enocson A, Hedbeck CJ, Tornkvist H, Tidermark J, Lapidus LJ. Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop. 2012;36:711–7.CrossRefPubMedCentralPubMed
11.
Ong BC, Maurer SG, Aharonoff GB, Zuckerman JD, Koval KJ. Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up. J Orthop Trauma. 2002;16:317–22.CrossRefPubMed
12.
Sabnis B, Brenkel IJ. Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures. J Orthop Surg (Hong Kong). 2011;19:8–12.
13.
Leonardsson O, Karrholm J, Akesson K, Garellick G, Rogmark C. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop. 2012;83:459–66.CrossRefPubMedCentralPubMed
14.
Abdelkhalek M, Abdelwahab M, Ali AM. Bipolar versus fixed-head hip arthroplasty for femoral neck fractures in elderly patients. Strategies Trauma Limb Reconstr. 2011;6:1–6.CrossRefPubMedCentralPubMed
15.
Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ. Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. J Bone Joint Surg (Br). 1996;78:391–4.
16.
Cornell CN, Levine D, O’Doherty J, Lyden J. Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly. Clin Orthop Relat Res. 1998;348:67–71.CrossRefPubMed
17.
Davison JN, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, et al. Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. J Bone Joint Surg (Br). 2001;83:206–12.CrossRef
18.
Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial. Int Orthop. 2013;37:2457–64.CrossRefPubMedCentralPubMed
19.
Jeffcote B, Li MG, Barnet-Moorcroft A, Wood D, Nivbrant B. Roentgen stereophotogrammetric analysis and clinical assessment of unipolar versus bipolar hemiarthroplasty for subcapital femur fracture: a randomized prospective study. ANZ J Surg. 2010;80:242–6.CrossRefPubMed
20.
Malhotra R, Arya R, Bhan S. Bipolar hemiarthroplasty in femoral neck fractures. Arch Orthop Trauma Surg. 1995;114:79–82.CrossRefPubMed
21.
Mishra AK, Chalise PK, Shah SB, Adhikari V, Singh RP. Comparative study in surgical outcome of intracapsular fracture neck of femur in active elderly patients treated with hemiarthroplasty with Austin Moore’s and bipolar prosthesis. Nepal Med Coll J. 2013;15:81–3.PubMed
22.
Raia FJ, Chapman CB, Herrera MF, Schweppe MW, Michelsen CB, Rosenwasser MP. Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res. 2003;414:259–65.CrossRefPubMed
23.
Stoffel KK, Nivbrant B, Headford J, Nicholls RL, Yates PJ. Does a bipolar hemiprosthesis offer advantages for elderly patients with neck of femur fracture? A clinical trial with 261 patients. ANZ J Surg. 2013;83:249–54.CrossRefPubMed
24.
Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76:15–25.PubMed
25.
Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;6:CD001706.PubMed
26.
Hedbeck CJ, Blomfeldt R, Lapidus G, Tornkvist H, Ponzer S, Tidermark J. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. Int Orthop. 2011;35:1703–11.CrossRefPubMedCentralPubMed
27.
Evaniew N, Madden K, Bhandari M. Cochrane in CORR ((R)): arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Clin Orthop Relat Res. 2014;472:1367–72.CrossRefPubMed
28.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.CrossRefPubMedCentralPubMed
29.
Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://​handbook.​cochrane.​org.
30.
31.
32.
Verberne GH. A femoral head prosthesis with a built-in joint. A radiological study of the movements of the two components. J Bone Joint Surg (Br). 1983;65:544–7.
33.
Phillips TW. The Bateman bipolar femoral head replacement. A fluoroscopic study of movement over a four-year period. J Bone Joint Surg (Br). 1987;69:761–4.
34.
Chen SC, Badrinath K, Pell LH, Mitchell K. The movements of the components of the Hastings bipolar prosthesis. A radiographic study in 65 patients. J Bone Joint Surg (Br). 1989;71:186–8.
35.
Eiskjaer S, Boll K, Gelineck J. Component motion in bipolar cemented hemiarthroplasty. J Orthop Trauma. 1989;3:313–6.CrossRefPubMed
36.
Rae PJ, Hodgkinson JP, Meadows TH, Davies DR, Hargadon EJ. Treatment of displaced subcapital fractures with the Charnley-Hastings hemiarthroplasty. J Bone Joint Surg (Br). 1989;71:478–82.
37.
38.
Georgiou G, Siapkara A, Dimitrakopoulou A, Provelengios S, Dounis E. Dissociation of bipolar hemiarthroplasty of the hip after dislocation. A report of five different cases and review of literature. Injury. 2006;37:162–8.CrossRefPubMed
39.
Sierra RJ, Schleck CD, Cabanela ME. Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and outcome. Clin Orthop Relat Res. 2006;442:230–8.CrossRefPubMed
Metadata
Title
Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials
Authors
Zhiwei Jia
Fan Ding
Yaohong Wu
Wei Li
Haifeng Li
Deli Wang
Qing He
Dike Ruan
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-015-0165-0

Other articles of this Issue 1/2015

Journal of Orthopaedic Surgery and Research 1/2015 Go to the issue

Research article

Comparison of rivaroxaban and parnaparin for preventing venous thromboembolism after lumbar spine surgery

Research article

Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach

Research article

Biomechanical analysis of the annular ligament in Monteggia fractures using finite element models

Research article

Utilization of a genetically modified muscle flap for local BMP-2 production and its effects on bone healing: a histomorphometric and radiological study in a rat model

Research article

Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage

Research article

Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for preventing secondary fracture after vertebroplasty