A Comparison of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation of Basicervical Femoral Neck Fractures

Abstract

Background: Surgical treatment of basicervical femoral neck fractures, which are biomechanically similar to intertrochanteric fractures, is an internal fixation by dynamic hip screw (DHS) and anti-rotation screw. Since one of the remarkable complications of this surgical procedure is device failure, we aimed to make a comparison between bipolar hemiarthroplasty and the DHS plate fixation in elderly patients with basicervical femoral neck fracture.

Methods: In this randomized controlled clinical trial study, 60 patients with femoral neck fractures were randomly divided into two groups of DHS fixation (control group, n = 30) and bipolar hemiarthroplasty (intervention group, n = 30). Harris Hip Score (HHS) questionnaire and the Visual Analogue Scale (VAS) for pain assessment were used for functional evaluations. Postoperative complications were evaluated at 6 months and one year postoperatively.

Results: The mean age was 73.95 ± 9.85 years in the hemiarthroplasty group and 74.22 ± 7.85 years in the internal fixation group. Three patients in the internal fixation group and 6 patients in the hemiarthroplasty group were excluded. HHS in 6 months and one year after surgery in the intervention group was dramatically higher than the control group. There were no noticeable changes in VAS scores between the two groups. Two cases of device failure happened in the control group.

Conclusions: It seems that bipolar hemiarthroplasty is more effective than internal fixation by DHS plate in improving the patient’s quality of life, considering higher HHS scores, earlier patient mobilization, shorter hospital stay, lower device failure rate, and lower revision rate