The research has been approved by our local Institutional Review Board (ID1825 n.90/2021).Īll surgical procedures were performed by posterolateral approach. Exclusion criteria included: less than 6 months of follow-up, patients younger than 75 years old, pathological femoral neck fractures, revision surgery, polytrauma patients needing additional procedures, rheumatic patients, patients with prior congenital hip dysplasia, Legg-Calve-Perthes disease, epiphysiolysis, or aseptic necrosis of the femoral head. In the setting of a retrospective comparative study involving the regional trauma center and 2 general hospitals, we collected data on 302 DFNF treated surgically with BHA or DMTHA, either cemented or press-fit, between January 2018 and September 2019. 17 The aim of the present retrospective multicentric comparative study was to assess surgical time, blood loss and transfusion, dislocation rate, mortality, and thromboembolic complications of 2 groups of patients with displaced femoral neck fracture treated with bipolar hemiarthroplasty and dual mobility total hip arthroplasty. Considering the characteristics of BHA and single bearing THA, DMTHA might represent the best compromise for the treatment of femoral neck fracture in elderly but active patients. 12 - 15 These implants, used in France since 1974, 16 aim to improve range of motion (ROM) and reduce dislocation rate compared to fixed bearing THA. Recently, improvements to dual mobility THA (DMTHA), such as higher resistance crosslinked PE 11 and update to neck design, corrected the issues affecting early implants and encouraged a wider use. 10 reported that THA has better results in terms of mortality, reoperation, adverse outcomes, function, and quality of life, and it is a better choice overall for displaced femoral neck fractures under 80 years old, despite a higher dislocation rate. A systematic review on the topic by Lewis et al. 9 Moreover, given the increased operative and post-operative risks of elderly patients, eliminating the likeness of a BHA to THA conversion must be considered when deciding between those implants. 8 However, it has been established that BHA can lead to acetabular erosion with the need of conversion to THA, increasing the final cost of implants. ![]() ![]() ![]() 6, 7 Bipolar hemiarthroplasty is traditionally considered a valid alternative for fragile, low demanding patients or those with cognitive disorders thanks to reduced blood loss, lower initial cost, and lower dislocation rate. 1 - 5 In case of DFNFs in active patients or on pre-existing hip osteoarthritis, THA represents the best performing choice, despite its higher initial costs and dislocation rate. Despite being an extremely common and resource consuming injury for national health services, most appropriate treatment for displaced femoral neck fractures (DFNFs) in the elderly is still a matter of debate between bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA).
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