Does the duration to bipolar hip arthroplasty for femoral neck fracture influence on postoperative muscular strength?

  • Nobuaki Chinzei
  • Mitsuaki NodaEmail author
  • Takehiko Matsushita
  • Atsuyuki Inui
  • Shin Osawa
  • Kenjiro Okimura
  • Masayasu Takahashi
  • Yasuhiro Saegusa
Original Article • HIP - ARTHROPLASTY



The primary purpose of this study was to compare the postoperative muscular strength and functional performance between early versus late bipolar hip arthroplasty (BHA) intervention for femoral neck fracture classified by the duration from the onset to surgery.


Twenty-one patients who could walk at 12 months or more after BHA were enrolled into this study. We examined the muscular strength of hip flexion, extension, abduction, and knee extension of these patients. Time of one-leg standing, timed up and go test, pain grade by visual analog scale, and Barthel index were also evaluated as functional indices. We classified these patients into two groups by the duration from the onset to surgery, namely: within 3 days until BHA (early OP) and more than 4 days (late OP) to compare these indices at the latest follow-up.


The mean days until operation were 2.3 days in the early-OP group and 5.9 days in the late-OP group, showing a significant difference between the two groups. Muscular strength and other functional indices were also found to have no significant differences between these two groups.


Our study suggests that the delay to operate might not severely compromise the muscular strength around the hip joint for least 1.5 years among ambulatory patients.


Bipolar hip arthroplasty Femoral neck fracture Muscular strength Activity of daily living 



The authors would like to thank Editage ( for the English language review. We also would like to express our special gratitude to our physiotherapists, Ms. Minami Sawauchi and Mr. Satoshi Kumagai, for their technical assistance.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Tsuda T (2017) Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Curr Orthop Pract 28(6):580–585. CrossRefGoogle Scholar
  2. 2.
    Bretherton CP, Parker MJ (2015) Early surgery for patients with a fracture of the hip decreases 30-day mortality. Bone Jt J 97-B(1):104–108. CrossRefGoogle Scholar
  3. 3.
    Atik OS (2019) There is an association between sarcopenia, osteoporosis, and the risk of hip fracture. Eklem hastaliklari ve cerrahisi Jt Dis Relat Surg 30(1):1. CrossRefGoogle Scholar
  4. 4.
    Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332(7547):947–951. CrossRefGoogle Scholar
  5. 5.
    Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. BMJ 293(6556):1203–1204CrossRefGoogle Scholar
  6. 6.
    Noda M, Saegusa Y, Takahashi M, Noguchi C, Yoshikawa C, Mikami H, Gotouda A (2017) Comparison of post-operative muscular strength between gamma nailing and hemiarthroplasty system in femoral intertrochanteric fractures. Open Orthop J 11:255–262. CrossRefGoogle Scholar
  7. 7.
    Mariconda M, Costa GG, Cerbasi S, Recano P, Aitanti E, Gambacorta M, Misasi M (2015) The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study. Bone Jt J 97-B(3):383–390. CrossRefGoogle Scholar
  8. 8.
    Crego-Vita D, Sanchez-Perez C, Gomez-Rico JA, de Arriba CC (2017) Intracapsular hip fractures in the elderly. Do we know what is important? Injury 48(3):695–700. CrossRefGoogle Scholar
  9. 9.
    Cawthon PM, Fox KM, Gandra SR, Delmonico MJ, Chiou CF, Anthony MS, Sewall A, Goodpaster B, Satterfield S, Cummings SR, Harris TB, Health A, Body Composition S (2009) Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc 57(8):1411–1419. CrossRefGoogle Scholar
  10. 10.
    Deren ME, Babu J, Cohen EM, Machan J, Born CT, Hayda R (2017) Increased mortality in elderly patients with sarcopenia and acetabular fractures. J Bone Jt Surg Am 99(3):200–206. CrossRefGoogle Scholar
  11. 11.
    Steele KM, Seth A, Hicks JL, Schwartz MS, Delp SL (2010) Muscle contributions to support and progression during single-limb stance in crouch gait. J Biomech 43(11):2099–2105. CrossRefGoogle Scholar
  12. 12.
    Uemura K, Takao M, Sakai T, Nishii T, Sugano N (2016) Volume increases of the gluteus maximus, gluteus medius, and thigh muscles after hip arthroplasty. J Arthroplasty 31(4):906–912. CrossRefGoogle Scholar
  13. 13.
    Rikkonen T, Poole K, Sirola J, Sund R, Honkanen R, Kroger H (2018) Long-term effects of functional impairment on fracture risk and mortality in postmenopausal women. Osteoporos Int 29(9):2111–2120. CrossRefGoogle Scholar
  14. 14.
    Mayoral AP, Ibarz E, Gracia L, Mateo J, Herrera A (2019) The use of Barthel index for the assessment of the functional recovery after osteoporotic hip fracture: one year follow-up. PLoS ONE 14(2):e0212000. CrossRefGoogle Scholar
  15. 15.
    Unnanuntana A, Jarusriwanna A, Nepal S (2018) Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture. Arch Orthop Trauma Surg 138(12):1671–1677. CrossRefGoogle Scholar
  16. 16.
    Fischer K, Trombik M, Freystatter G, Egli A, Theiler R, Bischoff-Ferrari HA (2019) Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis. Osteoporos Int. Google Scholar
  17. 17.
    Klestil T, Roder C, Stotter C, Winkler B, Nehrer S, Lutz M, Klerings I, Wagner G, Gartlehner G, Nussbaumer-Streit B (2018) Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 8(1):13933. CrossRefGoogle Scholar
  18. 18.
    Lim YW, Kwon SY, Han SK, Sun DH, Choi SP, Kim YS (2009) Postoperative mortality and factors related to mortality after bipolar hemiarthroplasty in patients with femoral neck fractures. J Arthroplasty 24(8):1277–1280. CrossRefGoogle Scholar
  19. 19.
    Schneppendahl J, Grassmann JP, Petrov V, Bottner F, Korbl B, Hakimi M, Betsch M, Windolf J, Wild M (2012) Decreasing mortality after femoral neck fracture treated with bipolar hemiarthroplasty during the last twenty years. Int Orthop 36(10):2021–2026. CrossRefGoogle Scholar
  20. 20.
    White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Jt Surg Am 69(9):1335–1340CrossRefGoogle Scholar
  21. 21.
    Navone P, Nobile M, Scognamiglio Pasini T, Piscitelli A, Colombo A, Mazzola S, Mazza EL, Colombo M, Calori GM (2017) Proximal femoral fractures in elderly people: time to surgery. The experience of Milan’s “ASST Pini/CTO”. Injury 48(Suppl 3):S39–S43. CrossRefGoogle Scholar
  22. 22.
    Zielinski SM, Keijsers NL, Praet SF, Heetveld MJ, Bhandari M, Wilssens JP, Patka P, Van Lieshout EM, Investigators FT (2013) Femoral neck shortening after internal fixation of a femoral neck fracture. Orthopedics 36(7):e849–e858. CrossRefGoogle Scholar
  23. 23.
    Noda M, Saegusa Y, Takahashi M, Takada Y, Fujita M, Shinohara I (2017) Decreased postoperative gluteus medius muscle cross-sectional area measured by computed tomography scan in patients with intertrochanteric fractures nailing. J Orthop Surg 25(3):2309499017727943. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryKonan HospitalKobeJapan
  2. 2.Department of Orthopaedic SurgeryNishi HospitalKobeJapan
  3. 3.Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeJapan

Personalised recommendations