MODERATE RECOMMENDATION Ten moderate quality studies (Calder 1995, Calder 1996, Davison 2001, Hedbeck 2011, Inngul 2013, Kanto 2014, Khan 2015, Parker 2020, Raia 2003, Stoffel 2013) and one low quality study (Kenzora 1998) included comparing outcomes of unipolar and bipolar hemiarthroplasty for treatment of displaced femoral neck fractures reported no significant differences in most of the outcome measures between the two groups. A meta-analysis of mortality at all time points showed no significant differences between these two groups.
Benefits/Harms of Implementation
Unipolar and bipolar hemiarthroplasty pose similar risk of adverse events. Composite Quality of Life (QoL) and functional outcome measures are overall not significantly between the two groups, although isolated statistically significant outcome differences were noted in some outcome measures that favored the bipolar group.
Outcome Importance
All outcome measures including QoL, function, adverse events, mortality, and pain are relevant to patients.
Cost Effectiveness/Resource Utilization
Most studies acknowledge lower cost of unipolar heads (Note: cost of implant is dependent on implant pricing at institutions and may not be lower at a specific institution).
Acceptability
No variation in acceptability between the two groups anticipated.
Feasibility
Surgical centers may not have equal access/availability to both unipolar and bipolar heads.
Future Research
Specific cost/resource utilization studies may be useful to compare these two groups.
- Chammout, G. K., Mukka, S. S., Carlsson, T., Neander, G. F., Stark, A. W., Skoldenberg, O. G. Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures: a randomized long-term follow-up study. Journal of Bone & Joint Surgery - American Volume 2012; 21: 1921-8
- Stoffel, K. K., Nivbrant, B., Headford, J., Nicholls, R. L., Yates, P. J. Does a bipolar hemiprosthesis offer advantages for elderly patients with neck of femur fracture? A clinical trial with 261 patients. ANZ Journal of Surgery 2013; 4: 249-54
- Raia, F. J., Chapman, C. B., Herrera, M. F., Schweppe, M. W., Michelsen, C. B., Rosenwasser, M. P. Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly?. Clinical orthopaedics and related research 2003; 414: 259-265
- Parker, M. J., Cawley, S. Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip: a randomized trial of 400 patients. Bone & Joint Journal 2020; 1: 11-16
- Khan, A. M., Anwar, S. F., Hafeez, S. Clinical outcome of cemented bipolar hemiarthoplasty versus Austin Moore hemiarthroplasty for displaced intracapsular fractures of hip in terms of anterior thigh pain in elderly. JPMA - Journal of the Pakistan Medical Association 2015; 11: S49-51
- Kenzora, J. E., Magaziner, J., Hudson, J., Hebel, J. R., Young, Y., Hawkes, W., Felsenthal, G., Zimmerman, S. I., Provenzano, G. Outcome after hemiarthroplasty for femoral neck fractures in the elderly. 1998; 348: 51-8
- Kanto, K., Sihvonen, R., Eskelinen, A., Laitinen, M. Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up. Archives of Orthopaedic & Trauma Surgery 2014; 9: 1251-9
- Inngul, C., Hedbeck, C. J., Blomfeldt, R., Lapidus, G., Ponzer, S., Enocson, A. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. International Orthopaedics 2013; 12: 2457-64
- Hedbeck, C. J., Blomfeldt, R., Lapidus, G., Törnkvist, H., Ponzer, S., Tidermark, J. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. International Orthopaedics 2011; 11: 1703-11
- Davison, J. N., Calder, S. J., Anderson, G. H., Ward, G., Jagger, C., Harper, W. M., Gregg, P. J. Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. Journal of Bone & Joint Surgery - British Volume 2001; 2: 206-12
- Calder, S. J., Anderson, G. H., Jagger, C., Harper, W. M., Gregg, P. J. Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. Journal of Bone & Joint Surgery - British Volume 1996; 3: 391-4
- Calder, S. J., Anderson, G. H., Harper, W. M., Jagger, C., Gregg, P. J. A subjective health indicator for follow-up. A randomised trial after treatment of displaced intracapsular hip fractures. Journal of Bone & Joint Surgery - British Volume 1995; 3: 494-6