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Bipolar versus monopolar hemiarthroplasty for displaced femur neck fractures: a meta-analysis study

  • Migliorini FilippoEmail author
  • Arne Driessen
  • Giorgia Colarossi
  • Valentin Quack
  • Markus Tingart
  • Jörg Eschweiler
General Review • HIP - FRACTURES
  • 35 Downloads

Abstract

Introduction

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 Last meta-analysis on this topic is outdated, and an update of current evidences is required.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).

Results

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.

Conclusions

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.

Keywords

Displaced femur neck fractures Hemiarthroplasty Bipolar Unipolar Acetabular erosion 

Notes

Acknowledgements

We would like to thank Pia Offermanns B. A., freelance editor, translator and proof-reader, for her professional editing of this study.

Funding

No external source of funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

References

  1. 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
  2. 2.
    Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD (2008) Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg 16(10):596–607CrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Bhattacharyya T, Koval KJ (2009) Unipolar versus bipolar hemiarthroplasty for femoral neck fractures: is there a difference? J Orthop Trauma 23(6):426–427.  https://doi.org/10.1097/BOT.0b013e3181adb057 CrossRefPubMedGoogle Scholar
  6. 6.
    Gilbert MS, Capozzi J (1998) Unipolar or bipolar prosthesis for the displaced intracapsular hip fracture? An unanswered question. Clin Orthop Relat Res 353:81–85CrossRefGoogle Scholar
  7. 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
  8. 8.
    Zhou Z, Yan F, Sha W, Wang L, Zhang X (2015) Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures in elderly patients. Orthopedics 38(11):697–702.  https://doi.org/10.3928/01477447-20151016-08 CrossRefPubMedGoogle Scholar
  9. 9.
    Abdelkhalek M, Abdelwahab M, Ali AM (2011) Bipolar versus fixed-head hip arthroplasty for femoral neck fractures in elderly patients. Strateg Trauma Limb Reconstr 6(1):1–6.  https://doi.org/10.1007/s11751-010-0100-1 CrossRefGoogle Scholar
  10. 10.
    Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ (1996) Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. J Bone Joint Surg Br 78(3):391–394CrossRefGoogle Scholar
  11. 11.
    Ng DZ, Lee KB (2015) Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly: is there a difference? Ann Acad Med Singapore 44(6):197–201PubMedGoogle Scholar
  12. 12.
    Stoffel KK, Nivbrant B, Headford J, Nicholls RL, Yates PJ (2013) Does a bipolar hemiprosthesis offer advantages for elderly patients with neck of femur fracture? A clinical trial with 261 patients. ANZ J Surg 83(4):249–254.  https://doi.org/10.1111/ans.12048 CrossRefPubMedGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3:e123–130.  https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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
  15. 15.
    Migliorini F, Biagini M, Rath B, Meisen N, Tingart M, Eschweiler J (2018) Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials. Int Orthop.  https://doi.org/10.1007/s00264-018-4124-3-&gt CrossRefPubMedGoogle Scholar
  16. 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. 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
  18. 18.
    Ayhan E, Kesmezacar H, Karaman O, Sahin A, Kir N (2013) Bipolar or unipolar hemiarthroplasty after femoral neck fracture in the geriatric population. Balkan Med J 30(4):400–405.  https://doi.org/10.5152/balkanmedj.2013.8571 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bauer S, Isenegger P, Gautschi OP, Ho KM, Yates PJ, Zellweger R (2010) Cemented Thompson versus cemented bipolar prostheses for femoral neck fractures. J Orthop Surg (Hong Kong) 18(2):166–171.  https://doi.org/10.1177/230949901001800207 CrossRefGoogle Scholar
  20. 20.
    Cornell CN, Levine D, O’Doherty J, Lyden J (1998) Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly. Clin Orthop Relat Res 348:67–71CrossRefGoogle Scholar
  21. 21.
    Davison JN, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, Gregg PJ (2001) 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 83(2):206–212CrossRefGoogle Scholar
  22. 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. 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. 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. 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. 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
  27. 27.
    Loo WL, Loh SY, Lee HC (2011) Is there a significant difference in surgery and outcomes between unipolar and bipolar hip hemiarthroplasty A retrospective study of a single institution in Singapore. Malays Orthp J 5(1):3–7.  https://doi.org/10.5704/moj.1103.001 CrossRefGoogle Scholar
  28. 28.
    Malhotra R, Arya R, Bhan S (1995) Bipolar hemiarthroplasty in femoral neck fractures. Arch Orthop Trauma Surg 114(2):79–82CrossRefGoogle Scholar
  29. 29.
    Mishra AK, Chalise PK, Shah SB, Adhikari V, Singh RP (2013) 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 15(1):81–83PubMedGoogle Scholar
  30. 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
  31. 31.
    Naveen PR, Kiran Kumar HG, Chatanya PR, Badami RN (2018) Prospective randomised control study of bipolar versus unipolar prosthesis in the management of fracture neck of femur in elderly patients. Int J Orth Sci 4(2):501–504.  https://doi.org/10.22271/ortho.2018.v4.i2h.77 CrossRefGoogle Scholar
  32. 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
  33. 33.
    Sabnis B, Brenkel IJ (2011) Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures. J Orthop Surg (Hong Kong) 19(1):8–12.  https://doi.org/10.1177/230949901101900103 CrossRefGoogle Scholar
  34. 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
  35. 35.
    Somashekar Krishna SV, Sridhara Murthy J (2013) Treatment of femoral neck fractures: unipolar versus bipolar hemiarthroplasty. Malays Orthop J 7(2):6–11.  https://doi.org/10.5704/MOJ.1307.007 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 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
  37. 37.
    Wathne RA, Koval KJ, Aharonoff GB, Zuckerman JD, Jones DA (1995) Modular unipolar versus bipolar prosthesis: a prospective evaluation of functional outcome after femoral neck fracture. J Orthop Trauma 9(4):298–302CrossRefGoogle Scholar
  38. 38.
    Balaji Z et al (2018) Unipolar austin moore’s prosthesis versus cemented bipolar in displaced neck of femur fracture in elderly patients. J Clin Diag Res 12(8):01–04.  https://doi.org/10.7860/JCDR/2018/32113.11865 CrossRefGoogle Scholar
  39. 39.
    Parvizi J, Pour AE, Peak EL, Sharkey PF, Hozack WJ, Rothman RH (2006) One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study. J Arthroplasty 21(6 Suppl 2):26–31.  https://doi.org/10.1016/j.arth.2006.04.013 CrossRefPubMedGoogle Scholar
  40. 40.
    Tidermark J, Ponzer S, Svensson O, Soderqvist A, Tornkvist H (2003) Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br 85(3):380–388CrossRefGoogle Scholar
  41. 41.
    Phillips TW (1987) The Bateman bipolar femoral head replacement. A fluoroscopic study of movement over a four-year period. J Bone Joint Surg Br 69(5):761–764CrossRefGoogle Scholar
  42. 42.
    Camurcu Y, Cobden A, Sofu H, Saklavci N, Kis M (2017) What are the determinants of mortality after cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients? J Arthroplast 32(10):3038–3043.  https://doi.org/10.1016/j.arth.2017.04.042 CrossRefGoogle Scholar
  43. 43.
    Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikeras O (2011) Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 35(6):903–907.  https://doi.org/10.1007/s00264-010-1149-7 CrossRefPubMedGoogle Scholar
  44. 44.
    Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W (2007) Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg 127(10):959–966.  https://doi.org/10.1007/s00402-007-0423-7 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL (2004) Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res 425:64–71CrossRefGoogle Scholar
  46. 46.
    Vosoughi AR, Emami MJ, Pourabbas B, Mahdaviazad H (2017) Factors increasing mortality of the elderly following hip fracture surgery: role of body mass index, age, and smoking. Musculoskelet Surg 101(1):25–29.  https://doi.org/10.1007/s12306-016-0432-1 CrossRefPubMedGoogle Scholar
  47. 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

Copyright information

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

Authors and Affiliations

  1. 1.Department of OrthopaedicsRWTH Aachen University ClinicAachenGermany
  2. 2.Department of Cardiothoracic SurgeryRWTH Aachen University ClinicAachenGermany

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