Comparative Outcomes of Bipolar vs. Austin Moore Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly

Bharathwaj D K ^1*, Indhumathi  Krishnaswamy ¹, Arun Shriram A ¹, Shreevithya D ¹

This study showed the superior functional recovery and reduced complications associated with bipolar hemiarthroplasty compared to Austin Moore prostheses in elderly patients.

Abstract

Background: Femoral neck fractures, particularly in the elderly, present significant clinical challenges and often require prosthetic replacement to restore functional activity. The choice between unipolar (Austin Moore prosthesis) and bipolar hemiarthroplasty remains contentious, with ongoing debate about their comparative effectiveness in terms of functional outcomes and patient satisfaction. This study aimed to evaluate and compare the functional outcomes of Austin Moore prosthesis (AMP) versus bipolar hemiarthroplasty in treating displaced femoral neck fractures in elderly patients. Methods: A prospective randomized controlled trial was conducted at the Department of Orthopaedics, SLIMS Pondicherry, from 2016 to 2019. The study included patients aged 60 years or older with displaced intracapsular femoral neck fractures. Exclusion criteria included significant comorbidities, arthritis, and pathological fractures. Participants were randomly assigned to two groups: one receiving AMP and the other receiving a bipolar prosthesis. Functional outcomes were assessed using the Harris Hip Score (HHS) at monthly intervals and at six months postoperatively. Results: The study enrolled 30 patients, with 15 in each group. In the bipolar prosthesis group, 14 (93.3%) patients achieved satisfactory outcomes, while 1 (6.7%) had an unsatisfactory outcome. In the Austin Moore group, 11 (73.3%) patients had satisfactory outcomes, and 4 (26.7%) had unsatisfactory outcomes. These results indicate a higher percentage of satisfactory outcomes with the bipolar prosthesis compared to the Austin Moore prosthesis. Conclusion: Bipolar hemiarthroplasty demonstrated superior functional outcomes compared to Austin Moore prosthesis in managing displaced femoral neck fractures in elderly patients. The bipolar prosthesis resulted in a higher percentage of satisfactory results, suggesting it as the preferable choice for this patient population. Further studies with longer follow-up are recommended to confirm these findings and explore long-term outcomes and complications.

Keywords: Bipolar Hemiarthroplasty, Austin Moore Prosthesis, Femoral Neck Fractures, Elderly Orthopedic Treatment, Functional Recovery

References

Agha, R. A., Borrelli, M. R., Vella-Baldacchino, M., Thavayogan, R., & Orgill, D. P. (2017). The STROCSS statement: Strengthening the reporting of cohort studies in surgery. International Journal of Surgery, 46, 198–202.

Bensen, A. S., Jakobsen, T., & Krarup, N. (2014). Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. International Orthopaedics, 38(6), 1241–1245.

Bousquet, G., Gazielly, D., Girardin, P., Debiesse, J., Relave, M., & Israeli, A. (1985). The ceramic coated cementless total hip arthroplasty: Basic concepts and surgical technique. Journal of Orthopaedic Surgery and Technology, 1, 15–28.

Burgers, P. T., Van Geene, A. R., Van den Bekerom, M. P., Van Lieshout, E. M., Blom, B., & Aleem, I. S. (2012). Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis and systematic review of randomized trials. International Orthopaedics, 36(8), 1549–1560.

Gierer, P., & Mittlmeier, T. (2015). Femoral neck fracture. Unfallchirurg, 118(3), 259-270. https://doi.org/10.1007/s00113-014-2729-6

Grazioli, A., Ek, E. T. H., & Rüdiger, H. A. (2012). Biomechanical concept and clinical outcome of dual mobility cups. International Orthopaedics, 36(12), 2411–2418.

Kannan, A., Kancherla, R., McMahon, S., Hawdon, G., Soral, A., & Malhotra, R. (2012). Arthroplasty options in femoral-neck fracture: Answers from the national registries. International Orthopaedics, 36(1), 1–8.

Keating, J. F., Grant, A., Masson, M., Scott, N. W., & Forbes, J. F. (2005). Displaced intracapsular hip fractures in fit, older people: A randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technology Assessment, 9(41), 1–65.

Lin, C.-C., Huang, S.-C., Ou, Y.-K., Liu, Y.-C., Tsai, C.-M., & Chan, H.-H. (2012). Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures. Asian Journal of Surgery, 35(2), 62–66.

Malik, A. A., Kell, P., Khan, W. S., Ihsan, K. M., & Dunkow, P. (2009). Surgical management of fractured neck of femur. Journal of Perioperative Practice, 19(3), 100–104. https://doi.org/10.1177/175045890901900303

Nizami, M. A., Ahmed, F., Shah, M. A., & Khan, T. B. (2009). Fracture neck of femur treated with cannulated screws in middle aged patients. Journal of the Pakistan Orthopaedic Association, 21, 45–51.

Parker, M. J. (2000). The management of intracapsular fracture. Journal of Bone and Joint Surgery, British Volume, 82, 937–941. https://doi.org/10.1302/0301-620X.82B7.0820937

Wang, F., Zhang, H., Zhang, Z., Ma, C., & Feng, X. (2015). Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis. BMC Musculoskeletal Disorders, 16, 229.

Zhao, Y., Fu, D., Chen, K., Li, G., Cai, Z., & Shi, Y. (2014). Outcome of hemiarthroplasty and total hip replacement for active elderly patients with displaced femoral neck fractures: A meta-analysis of 8 randomized clinical trials. PLoS One, 9(5).