Bipolar versus monopolar hemiarthroplasty for displaced femur neck fractures: a meta-analysis study
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Hemiarthroplasty is commonly performed to treat femoral neck fractures. Still, there is a lack of consensus concerning the best component for hemiarthroplasty: unipolar and bipolar implants. Last meta-analysis on this topic is outdated, and an update of current evidences is required. The purpose of this study is to conduct a meta-analysis comparing the unipolar versus bipolar implants for hemiarthroplasty, focusing on the clinical scores, perioperative data, further complications and mortality rate.
Materials and methods
In September 2019, the main databases were accessed: all the clinical trials comparing unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures were considered for inclusion. For the methodological quality assessment, we referred to the PEDro score. For the statistical analysis, we referred to the Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). For implant survivorship, we referred to the STATA/MP software version 14.1 (StataCorp, College Station, Texas).
A total of 27 articles were considered for inclusion, consisting of 16 randomized and 11 non-randomized clinical trials. A total of 4511 patients were enrolled, undergoing a mean 21.26 months follow-up. A statistically significant reduction in the acetabular erosion was observed in the bipolar group (OR 3.16, P < 0.0001). Although statistically insignificant, the bipolar group reported a reduction in the mean Harris hip score, reduced surgical duration and hospitalization, reduced dislocation and revisions rate. Concerning the mortality, a reduction across all the follow-ups in favor of the bipolar group was detected, but without statistically significance.
This meta-analysis evidenced a reduction in the acetabular erosion after bipolar hemiarthroplasty compared to the unipolar implants. Any statistically significant difference concerning the other endpoints of interest was detected. Current evidence concerning this topic are controversial, and further randomized clinical trials are required.
KeywordsDisplaced femur neck fractures Hemiarthroplasty Bipolar Unipolar Acetabular erosion
We would like to thank Pia Offermanns B. A., freelance editor, translator and proof-reader, for her professional editing of this study.
No external source of funding was used.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, informed consent is not required.
- 1.Cummings SR, Raisz LG (1996) Hip fracture. N Engl J Med 335(26):1994; author reply 1995–1996. https://doi.org/10.1056/nejm199612263352612
- 3.Sims AL, Farrier AJ, Reed MR, Sheldon TA (2017) Thompson hemiarthroplasty versus modular unipolar implants for patients requiring hemiarthroplasty of the hip: a systematic review of the evidence. Bone Joint Res 6(8):506–513. https://doi.org/10.1302/2046-3758.68.BJR-2016-0256.R1 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Yang B, Lin X, Yin XM, Wen XZ (2015) Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol 25(3):425–433. https://doi.org/10.1007/s00590-014-1565-2 CrossRefPubMedGoogle Scholar
- 7.Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM (2010) Treatment of femoral neck fractures in elderly patients over 60 years of age—which is the ideal modality of primary joint replacement? Patient Saf Surg 4(1):16. https://doi.org/10.1186/1754-9493-4-16 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Howick JCI, Glasziou P, Greenhalgh T, Carl Heneghan, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford CEBM levels of evidence. Oxford Centre for Evidence-Based Medicine. https://www.cebmnet/indexaspx?o=5653
- 16.Ahmed MJ, Shahid M, Ahmed MH, Nazar B (2018) Intracapsular femoral neck fractures; comparison of functional outcomes in unipolar versus bipolar uncemented hemiarthroplasty in elderly patients. Prof Med J 25(9):1317–1322Google Scholar
- 17.Ali AA, Rashed SM, Hussien MT (2014) Unipolar versus bipolar hip hemiarthroplasty in the treatment of femoral neck fractures in the elderly. Iraqi Postgrad Med J 13(4):475–485Google Scholar
- 22.Enocson A, Hedbeck CJ, Tornkvist H, Tidermark J, Lapidus LJ (2012) Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop 36(4):711–717. https://doi.org/10.1007/s00264-011-1326-3 CrossRefPubMedGoogle Scholar
- 23.Hedbeck CJ, Blomfeldt R, Lapidus G, Tornkvist H, Ponzer S, Tidermark J (2011) Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. Int Orthop 35(11):1703–1711. https://doi.org/10.1007/s00264-011-1213-y CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A (2013) Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Int Orthop 37(12):2457–2464. https://doi.org/10.1007/s00264-013-2117-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Jia Z, Ding F, Wu Y, Li W, Li H, Wang D, He Q, Ruan D (2015) Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 10:8. https://doi.org/10.1186/s13018-015-0165-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Jeffcote B, Li MG, Barnet-Moorcroft A, Wood D, Nivbrant B (2010) Roentgen stereophotogrammetric analysis and clinical assessment of unipolar versus bipolar hemiarthroplasty for subcapital femur fracture: a randomized prospective study. ANZ J Surg 80(4):242–246. https://doi.org/10.1111/j.1445-2197.2009.05040.x CrossRefPubMedGoogle Scholar
- 30.Naser MA, Pathak R, Ahmad A (2018) Superiority of fixed stem bipolar prosthesis over Austin Moore prosthetic in fracture neck femur. Int J Res Orthop 4(4):577–581. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182415 CrossRefGoogle Scholar
- 32.Raia FJ, Chapman CB, Herrera MF, Schweppe MW, Michelsen CB, Rosenwasser MP (2003) Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 414:259–265. https://doi.org/10.1097/01.blo.0000081938.75404.09 CrossRefGoogle Scholar
- 34.Shah RM, Patel DA, Rathi N (2015) A comparative study of outcomes of unipolar versus bipolar hemi-arthroplasty in geriatric age group—a study of 60 cases. Int J Sci Eng Res 6(12):1186–1219Google Scholar
- 36.Vishwanath C, Mummigatti SB (2017) Comparative study between Austin Moore prosthesis and bipolar prosthesis in fracture neck of femur. Clin Orthop 1(2):53–61Google Scholar
- 47.Flodin L, Laurin A, Lokk J, Cederholm T, Hedstrom M (2016) Increased 1-year survival and discharge to independent living in overweight hip fracture patients: a prospective study of 843 patients. Acta Orthop 87(2):146–151. https://doi.org/10.3109/17453674.2015.112528 CrossRefPubMedPubMedCentralGoogle Scholar