Aims. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). Methods. This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis. Results. Of 746 HAs performed in the HEALTH trial, 404 were bipolar prostheses and 342 were unipolar. After propensity score weighting, adequate balance between the bipolar and unipolar groups was obtained as shown by standardized mean differences less than 0.1 for each covariable. A total of 24 months after HA, the total WOMAC score and its subcomponents showed no statistically significant difference between the unipolar and bipolar groups. Similarly, no statistically significant difference was found in the PCS and MCS scores of the SF-12 questionnaire. In participants aged 70 years and younger, no difference was found in any of the functional outcomes. Conclusion. From the results of this study, the use of bipolar HA over unipolar design does not provide superior functional outcomes at 24 months postoperatively. The theoretical advantage of reduced acetabular wear with bipolar designs does not appear to influence functional outcomes in the first two years postoperatively. Cite this article: Bone Jt Open 2023;4(5):370–377

Purpose. To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty in reverse oblique intertrochanteric hip fracture in elderly patients. Materials and Methods. From January 2005 to July 2012, we reviewed 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and been followed up on for a minimum of 2 years. The patients, all over 70 years old, were divided into two groups for retrospective evaluation: one group was treated with open reduction and internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with bipolar hemiarthroplasty (22 cases). Results. Early ambulation postoperatively and less pain at postoperative three months were significantly superior in the bipolar hemiarthroplasty group. However, by 24 months postoperatively, the open reduction and internal fixation group had higher Harris scores and correspondingly less pain than the bipolar hemiarthroplasty group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the open reduction and internal fixation group underwent reoperation. Conclusions. In the treatment of intertrochanteric fracture of the reverse oblique type, if the patient's health and bone quality are good, open reduction and internal fixation is considered to be the better choice. However, in cases of severe communition of fracture and poor bone quality along with high risk of early reduction failure, bipolar hemiarthroplasty is an alternative offering advantages in terms of early ambulation, less pain at early stages, and lower risk of reoperation

Literature suggests in senile IT fracture group with osteoporosis and comminution, the rates of complications are very high. Documented figures show 16% deaths in non-operative treatment and 16% (late) non-union IT fractures in non operative treatment. The post fixation re-operation rate is 23% after two to three years. High rate implant cutout, penetration and plate cutout leads to increased morbidity and mortality again. The aim of this study is to find out the results of primary prosthetic replacement in comminuted, osteoporotic intertrochanteric fractures in elderly patients. Eight patients of the age group from 68 to 94 years (average 78.4) with four part fractures were operated primarily with bipolar hemiarthroplasty. They were operated by posterolateral approach and the hip joint was exposed through the fracture site itself. After pan release the proximal fragment was delivered and a modular locally manufactured cemented bipolar hemiarthroplasty was performed. Due care was taken to restore offset, limb length and soft tissue balancing. The patients were mobile early after two days with walker and they became independent within four weeks after operation. They were followed up from six months to 3.5 years (average 2.1 years). The functional and radiological evaluation was done. There were five females and three males. The modified Charnley score improved from average 2.3 pre-operatively to an average of 5.2 with respect to pain, mobility and function. All the patients were happy and independent. One patient developed abductor lurch, but managed to carry out independently all her activities of daily living. One patient had a dislocation. This lady was very unco-operative and never helped in the rehabilitation programme. She lost to follow-up. Radiologically, there were no signs of loosening, progressive adiolucent lines, subsidence or osteolysis at the latest follow-up. Primary prosthetic hemi-replacement in cases of osteoporotic four part fractures in elderly patients helps early restoration of function and thereby prevents complications

Purpose. We compared visible blood loss and calculated blood loss after bipolar hemiarthroplasty in femoral neck fracture, and evaluated correlation between blood loss and its risk factors. Materials and Methods: A total of 356 patients who underwent bipolar hemiarthroplasty in femoral neck fracture between 2004 and 2010 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score, use of cement, and use of antithrombotic agents. Results: Total calculated blood loss (1,408±72 ml) differed significantly from visible blood loss(980±102 ml). In addition, calculated blood loss differed between risk factors (1,526±369 ml in cardiovascular disease, 1,588±279 ml in general anesthesia, 1,645±920 ml in obesity, and 1,605±439 ml in use of antithrombotic agents). Conclusion: Total calculated blood loss was much greater than visible blood loss. Patients with risk factors such as cardiovascular disease, obesity, use of antithrombotic agents, and general anesthesia should be treated with care in order to reduce blood loss

Background. BHA is popular surgery for femoral neck fractures expecially elderly patients. However, clinical results are variable that factors affecting results are questionable. Therefore we investigated radiologic fators, dysplastic hip whether influences results of BHA. Methods. Between 2004 and 2009, 200 patients undergoing bipolar hemiarthroplasty for femoral neck fracture were divided two groups; a lateral center edge (LCE) angle of < 16 degree or > 16 degree on anteroposterior radiographs. All surgical procedures were performed by a single surgeon. Dermogrpahic data, the harris hip score, WOMAC index, Koval activity level, and complication were recorded. The minimum follow up interval was 4 years (mean, 7.8 years). Result. Late postoperative complications such as periprosthetic joint infection, acetabular erosion, and subluxation of bioplar head were commonly observed in a group <16 degree of center edge angle. Clinical score was significantly lower in dysplastic group. Revision rate was higher in dysplastic group compared with group LCE angle of above the 16 degree. Conclusion. These results suggest that the dysplastic nature might be affected result of bipolar hemiarthroplasty in femroal neck fracture especially elderly patients

Introduction: Surgeries in elderly individuals should be less invasive and less time consuming to reduce immediate postoperative morbidity and mortality. Nevertheless it should also give optimal long-term outcome thereby avoiding subsequent procedures in these high risk individuals. Bipolar hemiarthroplasty is a commonly performed orthopaedic surgery in elderly patients with fracture neck of femur. It is commonly believed that the type of implant and the nature of fixation (cemented or uncemented) influences both the short term and the long term outcome of this procedure. In this retrospective study we compared uncemented and cemented JRI furlong prosthesis. Method and materials: We had cohort of 60 patients who underwent cemented JRI bipolar hemiarthroplasty in the year of 2003 and 2004. We compared this cohort with the matched sample of 60 patients who underwent uncemented JRI bipolar hemiarthroplasty. We matched variables like age, ASA grade and the experience of surgeon. Results and Discussion: The perioperative variables like duration of surgery, amount of blood loss, length of hospital stay and postoperative complications (DVT, chest infection, mortality) were found to be less in the uncemented JRI group. However there are concerns about the long-term outcome of uncemented JRI hemi-arthroplasty in the form of peri prosthetic fractures. Out of 60 patients of uncemented JRI group 3 had peri prosthetic fracture as compared to none in the cemented JRI group. We believe this complication more likely could be due to excessive canal preparation and the press fit necessary for the primary stability of the implant. This warrants further prospective controlled trials to provide more evidence on this finding

Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. This study strictly defines the use of bipolar hemiarthroptasty for the entity of RCTA. Materials – Methods: We review our series of 14 patients with Rotator Cuff Tear Arthropathy (RCTA) who underwent a bipolar prosthesis of their shoulder. The average follow up was 27.8 months (range 24–48 months) and the average age was 71 years old (range 57–84 years old), of these 14 patients there were 9 male and 5 female. None of these patients had previous shoulder surgery and all patients underwent conservative treatment that failed to improve their symptoms or range of motion. Results: Preoperatively the average forward flexion was 300, external rotation 100 and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperativety the average forward flexion improved to 880, external rotation increased to 370 and the ASES score improved to 80 pts, 12 of the 14 patients stated that they had no pain with activities of daily living. Two patients persisted to have moderate pain in everyday activity. Conclusion: We believe that bipolar hemiarthroplasty is currently a good option for treatment of Rotator Cuff Tear Arthropathy, The results of bipolar hemiarthroplasty provided more reliable pain relief than that for hemiarthroplasty

Introduction. In the case of bipolar hemiarthroplasty, surgeons are often faced with only migration of outer head and severe osteolysis in acetabulum without loosening of femoral component. There has been much debate regarding the merits of removing or retaining stable femoral components in such cases. The purpose of this study was to determine whether revision of an isolated acetabular component without the removal of a well-fixed femoral component [Fig. 1] could be successfully performed. Materials and methods. Thirty-four hips of 33 patients who were followed up for a minimum of 1 year were examined. There were 29 women and 4 men. The average time from primary operation to revision surgery was 12.5 years (range, 0.0 to 17.9 years), and the average follow-up time after revision was 5 years (range, 1.1 to 15.2 years). The average age of the patients at the time of the index revision was sixty-four years (range, thirty-two to seventy-eight years). The reason for acetabular revision was migration of outer head in twenty-eight hips, disassembly of bipolar cup in four hips and recurrent dislocation in two hips. Of the thirty-four femoral components, twenty-seven were cementless and seven were cemented. In nine hips, we performed bone grafting to osteolysis of the proximal femur around the stem. Acetabular components were revised to an acetabular reinforcement ring with a cemented cup in 26 hips, to cementless acetabular components in 8 hips, and to cemented cup in 1 hip. Results. The average Japan Orthopaedic Association hip score improved from 50.7 to 86.1 points after revision surgery. One femoral component (3%) was revised because of periprosthetic fracture, three years after the index acetabular revision and eighteen years after the initial bipolar hemiarthroplasty. Radiographic evaluation of the thirty-three femoral components that were not revised demonstrated no evidence of loosening or subsidence. There were no dislocation or deep infection. Thirty-three (97%) of the acetabular components were judged to be stable at the final follow-up. A nonprogressive radiolucent line of less than 2 mm was observed in one case. Conclusion. We recommend that isolated acetabular revision be considered in cases of failed bipolar hemiarthroplasty with a well-fixed femoral component

Purpose. To perform comparative analysis between the results of internal fixation using proximal femoral nail system and bipolar hemiarthroplasty in pantrochanteric hip fracture in elderly patients. Materials and Methods. From January 2006 to February 2012, we reviewed 43 patients, who were treated surgically for pantrochanterichip fractures, with a minimum of 2 years follow up. The patient's age was older than 70 year old. The patients were divided into three groups and evaluated, retrospectively. The fracture reduction were regarded as satisfactory in S-OR-IF group(17 cases) and unsatisfactory in US-OR-IF group(9 cases) and the other group was treated with bipolar hemiarthroplasty (BHA group, 17 cases.). Results. At 24 months post-operation, S-OR-IF group had higher Harris scores, less pain, and better walking ability than S-OR-IF and BHA group. Six patients in the internal fixation group (one with S-OR-IF and five with US-OR-IF) had got reoperation. Conclusion. For pantrochanteric fractures of old-aged patient over 70 years old, bipolar hemiarthroplasty has few of severe complications which needs reoperation, and has good results of early ambulation. However, satisfactory reduction and internal fixation makes better clinical results in long term follow-up

Purpose. We evaluated the clinical and radiographic outcomes of cementless bipolar hemiarthroplasty using rectangular cross-section stem for femoral neck fracture in elderly patients more than 80 years of age with osteoporosis. Material and Methods. 76(cemented 46, cementless 30) bipolar hemiarthroplasties for femur neck fracture were performed in elderly patients more than 80 years old. The mean follow-up period was 4.3 years (2 to 7 years). The Harris hip score at last follow-up and pre-postoperative daily living activity scale according to Kitamura methods were analyzed clinically. The radiological results were assessed using stability of femoral stem and other complications were evaluated. Results: At last follow-up, there were no significant differences of Harris hip score and daily living activity between two groups. Stem loosening and instability were not observed in cementless arthroplasty. There were 18 cases of osseous fixation in radiologic study. There were 1 case of dislocation and 1 case of superficial infection in cemented arthroplasty and 1 case of deep infection in cementless arthroplasty. Conclusion. Cementless bipolar hemiarthroplasty using rectangular cross-section stem for elderly patients with a femoral neck fracture showed satisfactory short-term clinical and radiological results compared to using cement stem

Purpose: We will present our experience regarding sub-capital femoral fractures that were treated by cemented bipolar hemiarthroplasty with Chanley stem during the years 1987 to 2002. Method: We treated 159 patients with subcapital femoral fractures, type Garden stage 3 and 4. Of those 57 were men and 102 women aged between 65 and 85 years old. All the patients underwent surgical treatment by the same surgeon team, using cemented bipolar hemi-arthroplasty Hastings types, with Chanley stem. The preferred surgical approach was the anterolateral with partial incision of the gluteus medius muscle and preservation of the posterior capsule of the hip joint, so that the prosthesis would be stable and the abductor muscles retained their strength. Results: The observation time ranged from 6 months to 15 years. During this period 38 patients passed away and 24 never returned for follow up. The observed complications were: 1 aseptic loosening of the femoral stem that was dealt with THA, 1 superficial inflammation that was taken care of with surgical cleaning and antibiotic administration and 1 dislocation of the metal cup (with the internal polyethylene bearing) from the femoral stem that was corrected by OR. Postoperative hip mobility was found to be excellent (62%), fair (32%), poor (6%). 6 patients reported light to moderate pain during walking. We observed that the dual motion of the bipolar prosthesis is considerably reduced and eventually disappears over time. Conclusions: From our long time experience regarding subcapital femoral fractures types Garden 3 and 4 in patients aged between 65 and 80 years old, we believe that the cemented bipolar hemiarthroplasty is a very good method of choice

We developed a modified posterior approach that preserved the short external rotator muscles to prevent dislocation after THA or BHA. The present study aimed to evaluate the effectiveness of short external rotator preserving posterior(ERP) approach for bipolar hemiarthroplasty in treatment of femoral neck fractures in patients with neurologic disorders. Between March 2004 and February 2006, we performed 187 cementless bipolar hemiarthroplasties for displaced femoral neck fractures on 36 patients with neurologic disorders, who were operated on by ERP approach (Group 1) and 151 patients without neurologic deficits, who were operated on by conventional posterolateral approach (Group 2). We compared operation time, the amount of postoperative blood loss, the early postoperative complication rates, the dislocation rate within 1 year, and duration of hospital stay between two groups. The amount of postoperative blood loss was significantly decreased in group 1(p < 0.01). There were no significant differences in mean operation time and early postoperative complication rate including wound problem, deep vein thrombosis or infection and duration of hospital stay. There was no dislocation after operation in group 1, but seven patient (4.6%) had dislocation in group 2. Nine patients (25.0%) died within postoperative 1 year in group 1 and twenty six patients (17.2%) died in group 2. Cementless bipolar hemiarthroplasty through ERP approach provides a favorable outcome for treatment of displaced femoral neck fracture in patients with neurologic disorders who is considered as high risk of dislocation. Also, it decreases the postoperative blood loss and the needs of postoperative abduction brace

The purpose of this study was to review the midterm results of HAC coated bipolar hemiarthroplasty in patients with displaced intracapsular fracture neck of femur in elderly patients. There were 264 patients with 274 fractures from November, 2001, to June, 2004. The operations were performed by employing a similar technique and anterolateral approach. Postoperative treatment was same. The mobility was assessed by ambulation. Pain was evaluated using a visual analogue scale and clinical evaluations were performed using the Harris Hip Scoring System. The mean age of 142 survived patients reviewed in the study was 77.5 years (range 61-89 years) at the time of operation and mean follow-up was 25 months (range 18-48 months). Hundred and twenty six patients had no or mild occasional pain but no restriction of activity. Ninety of the ninety eight able to walk independently or with one stick before fracture were doing the same. The surviving implants were radiographically stable and demonstrated evidence of osseointegration and no acetabular wear. Harris hip score averaged 84 points. Fourteen patients (10%) scored 90-100, 80 patients (56%) scored 80-89, 42 patients (30%) scored 70-79, and 6 patients (4%) scored less than 70. We conclude that patients who score grade 1-3 of American Society of Anaesthesiologist and are mobile preoperatively outside their own home either independently or with one stick are better treated with HAC coated bipolar hemiarthroplasty with extra benefit of easy and quick conversion to total hip replacement if required in future

Introduction: We studied the possible causes of intraoperative metaphyseal fractures in elderly patients with displaced intracapsular fracture neck of femur treated with an HAC coated bipolar hemiarthroplasty and their effect on patient morbidity. Methods: 326 patients with 337 displaced intracapsular fractures admitted from November, 2001, to November, 2005 were included. They underwent Furlong bipolar hemiarthroplasty marketed by Joint Replacement Instrumentation Ltd (JRI). The operations were performed by employing a similar technique and anterolateral approach. Postoperative management was same. Results: Thirty five (10.25%) patients sustained an intraoperative metaphyseal fracture. We found a strong correlation between the incidences of metaphyseal fracture and stem size. Size 9 stem was used in 80 patients without any fracture. Stem size 10 was used in 159 patients and was associated with metaphyseal fractures in 14 patients (8.80%); size 12 stem was used in 98 patients with 21 metaphyseal fractures (21.42%). Vancouver type AL fractures were 26 and 9 type AG. The fracture was found to be unstable and fixation was undertaken in 7 patients. The mean hospital stay for the patients without metaphyseal fracture was 24 days (range 2–83) in comparison to 30 days (range 17–96) for patients with fractures. Thirty one patients presented from 3–18 months after operation with hip related problems, 17 had thigh pain, 10 periprosthetic fractures but 8 of these 27 had history of intra-operative metaphyseal fractures. Four patients had revision surgery, one each for acetabular erosion and sinking of prosthesis due to old metaphyseal fracture, two had Girdlestone arthroplasty due to deep wound infection. Conclusion: We conclude that a size 12 stem was associated with high complications rate because there is a big jump for the elderly patients from size 10 to 12 due to the non-availability of size 11 stem in this system. We observed the effect on patient morbidity due to metaphyseal fractures

Aims: The aim of this retrospective study was determine the survivorship of bipolar arthroplasty for femoral neck and what kind of associated factors could inßuence this survival rate. Methods: From 1980 until 2000, a total of 271 bipolar hemiarthroplasties were inserted for displaced femoral neck fractures in 269 patients, 207 were women and 64 were men, 62,4% cemented and 37,6% uncemented. The median age was 67,5 years (range: 28–93). The median follow-up was 74.6 months (range: 1–232). They were excluded pathologic fractures, osteoarthritis and dysplasic hips. We have studied the relationship between survivorship and presumed prognostic factors like age, sex and cementation. We used Kaplan-Meier method for calculating survival rates and Log-Rank test to assess prognostic factors. Results: Twenty-three (8,5%) hips required revision surgery, 3 were septic (1,1%) and 20 were aseptic (7,4%). In aseptic group we could þnd stem loosening (4,1%), polyethylene failure (1,4%), acetabular erosion (1,1%) and dislocation (0,7%). The 5- and 10-year hemiarthroplasty survival (HS) rates were 96% and 93% respectively. We found that only age< 60 years was signiþcant prognostic factor for HS (p< 0.05). Sex and cementation has not inßuenced signiþcantly on survival rate (p> 0,05). Conclusions: According to the outcomes in our group, we feel bipolar arthroplasty should be the technique of choice in patients over 60 years with sufþcient walking ability, when they have a displaced femoral neck fracture

The management of displaced femoral neck fractures in independent, healthy patients remains controversial. Acetabular erosion is a time dependant phenomenon and our aim was to assess the long-term outcome of the Universal Head bipolar with an Exeter stem. 49 consecutive cemented bipolar hemiarthroplasties were performed in 49 patients between 1992 and 2000. Mean age was 71.6 (range 54–91). There were 13 male and 36 female. 23 patients were alive at final follow up. 17 patients were assessed in outpatients with clinical and radiographic assessment. 2 patients had a telephone questionnaire and 4 patients were lost to follow up or were unable to attend clinic. Kaplan-Meier Survivorship analysis was performed. Median follow up was 7.1 years (range 5–13.3 years). 26 patients had died by the time of final follow up. 5/14 patients (36%) with an ASA score of 3 died within 30 days. There was one dislocation and one periprosthetic fracture. There were no deep infections. There were no revisions for aseptic loosening or acetabular erosion. 75.6% of surviving patients returned to their pre-injury mobility level at 1 year. 5 year cumulative survival was 60% (95% confidence interval 46–74%). There was a statistically significant reduction in cumulative survival for ASA grades 3 and 4 compared to 1 and 2 (p=0.004). Cemented bipolar hemiarthroplasty for femoral neck fractures is a good alternative to Total Hip Arthroplasty for independent, healthy patients. There is no evidence of acetabular erosion. Careful patient selection is necessary as patients with high ASA scores have greater mortality rates regardless of surgical prosthesis

Introduction: Between 1985 and 1995 an uncemented Osteonics hip prosthesis with bipolar Universal Head was the implant of choice in young patients with osteonecrosis of the femoral head and with posttraumatic secondary osteoarthritis of the hip. Materials and Methods: 30 bipolar hemiarthroplasties were performed in 24 patients with an average age of 34 years. Twenty-six hips had osteonecrosis of the femoral head and 4 hips had secondary osteoarthritis. All prostheses were Osteonics Omnifit collarless stems with an UHR universal head. 11 were non-HA-coated prostheses (NG) and 19 proximal HA-coated prostheses (HA). The mean duration of follow-up was 10.4 years. Results: Clinically, at final follow-up, the Harris Hip Score increased from a preoperative average of 41 points to 76 points (NG 70 and HA 80 points). Thigh or groin pain was present in 16 of 30 hips (NG 3/11 and HA 10/19). Radiographically, a subsidence of 5 mm or more was the major problem in the non-coated prostheses, 11 of 30 hips (NG 10/11, HA 1/19), but osteolysis was mainly seen in the HA-coated group, 20 of 30 hips (HA 17/19, NG 3/11). Total proximal migration of 5 mm or more of the bipolar head was found in 18 prostheses (NG 5/11 and HA 13/19). The revision rate for aseptic loosening was 8 of the 30 hips (NG 3/11 and HA 5/19). During the revisions, major destruction of the polyethylene (PE) inserts were found. Discussion: The revision rate of the Osteonics Omnifit Prosthesis with bipolar UHR is too high to use this implant in young patients with ON. Bone destruction due to third body wear is probably the main cause. Extensive proximal femoral bone loss is seen predominately in the HA group. The loosening rate in the HA-coated group showed no difference with the non-coated group although the reason for this is different

Background. A well conducted randomised study found similar functional results for patients with displaced femoral neck fracture comparing operation with a modern uncemented bipolar hemiarthroplasty with a cemented bipolar hemiarthroplasty. The mortality associated with the two procedures has not been sufficiently investigated. Aim of study. To investigate the mortality and the risk factors for death among patients with displaced femoral neck fractures the first year after surgery, comparing operation with modern uncemented and cemented bipolar hemiarthroplasty (HA). Methods. 8,636 patients (65 years and older) with displaced femoral neck fractures (Garden 3 and 4) operated with a cemented (n = 6,907) or a uncemented bipolar HA (n = 1,729) were selected from the files of The Norwegian Hip Fracture Register 2005–2009. Mortality was assessed using Kaplan-Meier survival analysis and risk factors of death were investigated using Cox-regression analysis. A power analysis showed the study sample to be sufficient to detect a difference in mortality of 3% at one year postoperatively. Results. Overall mortality one year postoperatively was 27%. We found no difference in the risk of death when comparing operation with cemented with uncemented bipolar HA one year (RR = 0.97, p = 0.51), 240 days (RR = 1.00, p = 0.95), 120 days (RR = 1.04, p = 0.57), and 30 days (RR = 1.12, p = 0.23) postoperatively. However, 10 days postoperatively there was an increased risk of death for patients operated with cemented HA compared to those operated with uncemented bipolar HA (RR = 1.34, p = 0.03). High age, male gender, cognitive impairment, increasing ASA score, and delay in surgery >48 hours after injury were all associated with an increased risk of death one year postoperatively. Interpretation. The early increased risk of death for patients operated with a cemented HA might be caused by the bone cement implantation syndrome. Our results further indicate that the difference in mortality one year postoperatively is likely to be less than 3%

Purpose. According to Bipolar Hemiarthroplasty of the Hip (BHA), several reports indicated earlier acquisition of walking ability in direct anterior approach (DAA) than posterior approach (PA), but there is still few randomized studies comparing accuracy of stem insertion in DAA and PA. Therefore, we performed a prospective study, focusing positioning of implant. Patient and Methods. We chose 29 patients for this study, diagnosed as femoral neck fracture (Garden grade III or IV) from April 2012 to April 2013, excluding obesity patients (body mass index upper than 30kg/m. 2. ), muscular patients, osteoporotic patients (Sigh grade I or II), and tumor bearing patients. Patients were enrolled in a prospective, non-blinded study and were randomly assigned by envelope method to receive either DAA or PA. Taperloc BHA system (Zimmer) was adapted for all cases. Patient condition, operation condition and radiographic findings were investigated. On CT imaging, Canal fill was calculated Stem fill was studied at lower point of lesser trochanter that was considered to be load center. Static analysis was carried out using SPSS ver21 (IBM. c. ). Continuous variables between the two groups were compared using a no matched bilateral Student's t-test. For nominal variables we used χ. 2. test. P value <0.05 was considered to be significant. (Table1). Result. There was no significant difference in the head size (DAA43.7/PA45.1mm, p=0.628), stem size (DAA10.6/PA10.8, p=0.739) and total blood loss (DAA198.3/PA146.7ml, p=0.41). Duration of operation was significantly longer in the DAA group at 85.61 min in comparison with 61.75 min in the PA group (p<0.001). One fracture of the greater trochanter during surgery was occurred in DAA group. This case needed cable fixation around greater trochanter. No symptomatic pulmonary embolism occurred, but deep vein thrombosis was detected in three patients in DAA group and in two patients in PA group. Canal fill calculated by CT imaging was no significant difference between both groups (DAA67%/PA71%, p=0.12). All patients were discharged to a rehabilitation facility. Modified Harris Hip score at the discharge assessed early clinical result. There was no significant difference between both groups (DAA45.7/PA49.1, p=0.713). To evaluate the learning effect of the operative outcome, we divide both groups into halves. We defined the first half of subgroups as early phase and the last half of subgroups as late phase. In the DAA group, significant improvement was observed in canal fill and there was a tendency of total blood loss to be lesser (Table 2). In the PA group, on the other hand, no improvement was observed for any values (Table 3). Discussion and conclusion. We performed a prospective randomized study. The strengths of this study include the standardized protocol about stem component and surgical team. There were significant difference with duration operation in this study. This facilitates accurate radiographic assessment so that we could analyze more reliable data. This study is a preliminary study and probably sample size may be inadequate. We can also ignore the effect of learning curve especially in the DAA group

Worldwide, it is expected that 6.3 million patients will sustain a hip fracture in 2050. Hemiarthroplasty is commonly practiced for displaced femoral neck fractures. The choice between unipolar (UH) or bipolar (BH) hemiarthroplasty is still controversial. The objective of this study was to assess the effect on hip function of BH compared to UH for a displaced femoral neck fracture in elderly patients. We conducted a systematic review and meta-analysis of randomized controlled trials comparing BH to UH. Data sources were Medline, Embase, Cochrane Library and Web of Science. All data was pooled in Review Manager (RevMan) version 5.3 software. Selection of the studies included, data abstraction, data synthesis, risk of biais and quality of evidence evaluation was done independently by two authors. Our primary outcome was postoperative hip function. Secondary outcomes were health-related quality of life (HRQoL), acetabular erosion and postoperative complications. 13 randomized controlled trials (n=2256) were eligible for the meta-analysis. There was no difference in hip function scores (standardized mean difference of 0.33 [−0.09–0.75, n=864, I. 2. = 87%,]). Patients with bipolar heads had higher Health-Related Quality of Life scores than patients with unipolar heads (mean difference in EQ-5D scores of 0.12 [0.04–0.19, n=550, I. 2. = 44%]). The use of BH decreased the incidence of acetabular erosion (relative risk of 0.37 [0.17–0.83, n=525, I. 2. = 0%]). There was no relative risk difference for mortality, dislocation, revision and infection. Due to the high heterogeneity between the studies included, it is still unclear whether patients undergoing BH have better hip function than patients undergoing UH. Although, health-related quality of life (HRQoL) may be improved. Future research could be conducted to determine whether a BH offers a better quality of life than UH to geriatric patients undergoing surgery. More precise assessment scores could be developed to better evaluate postoperative outcomes