A comparative study of functional outcome of bipolar hemiarthroplasty versus total hip arthroplasty in fracture neck of femur in elderly patients

Abstract

Introduction: Fractures of the femoral neck are an international public health problem mainly occurring in elderly patients and resulting in high mortality. With the aging population, the incidence of these fractures is steadily increasing. Treatment choices for the neck of femur fractures in the elderly age group includes hemiarthroplasty (HA) and total hip replacement (THR). The treatment option must be decided by the type of fracture, condition of the patient, functional demands, medical and mental ability to cope with the surgery. This study compares bipolar hemiarthroplasty (BH) and total hip replacement (THR) in elderly patients with neck of femur fracture. Aim: To evaluate the functional outcome, complications and mortality of Bipolar Hemiarthroplasty and Total Hip Arthroplasty as a treatment modality in neck of femur fracture patients. Materials and Methods: A prospective study was conducted in the Department of Orthopaedics, Rajah Muthiah medical college, in which 30 Patients of age 55 years and above who underwent hip arthroplasty (BHA or THA) for neck of femur fracture with follow up were included. Patients were separated into two groups by random allocation. Patients of group 1 (15 patients) were treated by bipolar hemiarthroplasty and group 2 (15 patients) by total hip arthroplasty. Both groups were followed up post-operatively for one year, at 6, 12 months, for surgical complications including dislocation, fracture, surgical site infection, and, one-year mortality and functional outcome using Modified Harris Hip Score. Results: Modified Harris Hip Score was higher in Total hip arthroplasty group compared to bipolar hemiarthroplasty group, pain was similar in both groups post operatively. Gait and range of motion were higher in the Total Hip Arthroplasty group, no significant difference was seen in mortality and post-operative complications between the two groups. Conclusion: In our study, we conclude that Total hip arthroplasty is ideal to treat femoral neck fractures in elderly patients with arthritic changes and has a lower risk of re operation when compared to Bipolar hemiarthroplasty, however bipolar hemiarthroplasty has a better outcome in cases of acute femoral neck fractures, based on our study.