Fri., 10/15/10 Geriatrics, Paper #42, 10:23 am OTA-2010
Bipolar Hemiarthroplasty Compared with Total Hip Arthroplasty in Patients with Displaced Femoral Neck Fractures: A Four-Year Follow-Up of a Randomized Controlled Trial (FDA=Non-U.S. research conducted within guidelines of my country)
Carl Johan Hedbeck, MD1; Anders Enocson, MD, PhD1; Gunilla Lapidus, MD2;
Richard Blomfeldt, MD, PhD1; Hans Törnkvist, MD, PhD1;
Sari Ponzer, PhD1; Jan Tidermark, MD, PhD1;
1Karolinska Institutet, Dept. of Clinical Science and Education, Sodersjukhuset,
Stockholm, Sweden;
2Unilabs St. Goran Radiology, Capio St. Goran Hospital, Stockholm, Sweden
Purpose: The primary aim of the study was to determine whether the superior hip function for total hip arthroplasty (THA) as compared to bipolar hemiarthroplasty (HA) after 1 year (Blomfeldt et al, J Bone Joint Surg Br. 2007;89:160-165) persisted during the 4-year follow-up. The secondary aim was to analyze the degree of acetabular erosion in the HA group during the same period of time.
Methods: 120 patients (101 females [84%]; mean age, 81 years) with an acute displaced femoral neck fracture were randomized to a bipolar HA or a THA. The inclusion criteria were age 70 to 90 years, absence of severe cognitive dysfunction, independent living status, and independent walking capability. Hip complications, hip function according to the Harris hip score (HHS) and health-related quality of life (HRQoL) according to the EQ-5D were assessed. Acetabular erosion was graded (0-3) according to Baker et al (J Bone Joint Surg Am. 2006;88:2583-2589).
Results: There were no significant differences in hip complications and reoperations between the groups and there were no dislocations. In the HA group, a total of 5 patients presented with acetabular erosion, all grade 1, but not affecting hip function. The difference in hip function (HHS) in favor of the THA group previously reported at 1 year persisted and seemed to increase with time—score 87 versus 78 at 24 months (P < 0.001) and 89 versus 75 at 48 months (P < 0.001). The HRQoL (EQ-5D index score) was assessed better in the THA group at each follow-up, but the difference was statistically significant only at 48 months (P < 0.039).
Conclusion: The results confirm the better outcome for hip function and quality of life after THA compared to HA in elderly, lucid patients with a displaced fracture of the femoral neck. The results imply that THA should be the preferred treatment method for the active, relatively healthy patient with long life expectancy. However, the low rate of acetabular erosion after 4 years and the relatively good hip function after a modern bipolar HA imply that a bipolar HA may suffice as treatment for the oldest patients with lower functional demands.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.