Bipolar or Unipolar Hemiarthroplasty after Femoral Neck Fracture in the Geriatric Population

Abstract

Background: The choice of prosthesis in hemiarthroplasty is controversial for geriatric patients after femoral neck fracture. We hypothesised that selection criteria for unipolar or bipolar prostheses could be constructed based on factors affecting mortality. Aims: The aims of this retrospective study were: (1) to determine the factors affecting mortality of femoral neck fracture patients ≥65 years of age; (2) to compare patient mortality rates, radiological findings, and functional outcomes according to prosthesis type (unipolar or bipolar); and (3) to evaluate the persistence of inner bearing mobility of bipolar prostheses. Study Design: Retrospective comparative study. Methods: In total, 144 patients operated for hemiarthroplasty and aged ≥65 were included. We classified the patients into either unipolar or bipolar prosthesis groups. To reveal factors that affected mortality, age, sex, delay in surgery, and American Society of Anesthesiologists score were obtained from folders. Barthel Daily Living, Harris hip, and acetabular erosion scores were calculated and bipolar head movement was analysed for live patients. Results: One-year mortality was 31.94%. Age ≥75 (p=0.029), male sex (p=0.048), and delay in surgery ≥6 (p=0.004) were the patient characteristics that were related to increased mortality. There were no significant differences in sex, age, American Society of Anesthesiologists score, delay in surgery, mortality, or Barthel, Harris, acetabulum scores between the two groups. Twenty patients from each group were admitted for last follow-up. Bipolar head movement was preserved for 33.3% of patients. They were inactive patients with low Barthel and Harris scores. Conclusion: Although bipolar head movement was preserved in inactive patients, we suppose that this conferred no advantage to these patients, who could hardly walk. In this study, male patients, those aged ≥75 years, and those operated at ≥6 days had an increased risk of mortality. Also, although not significant in multivariate analysis, high American Society of Anesthesiologists score (≥3) was related to increased mortality. Considering that one of three patients died during the first postoperative year, we think that these patients should be operated as soon as possible, and expensive bipolar prostheses must be used selectively in regard to patient characteristics. Turkish Başlık:Geriatrik Nüfusta Femur Boyun Kırıkları Sonrası Bipolar veya Unipolar Hemiartroplasti Anahtar Kelimeler:Femur boyun kırığı, mortalite, hemiartroplasti Arkaplan: Yaşlı hastalarda hemiartroplasti ile femur boyun kırığı tedavisinde protez tipi tercihi tartışmalıdır. Biz çalışmamızda mortaliteyi etkileyen faktörleri baz alarak unipolar veya bipolar protez için tercih ölçütleri oluşturabileceğimizi düşündük. Amaç: Bu retrospektif çalışmanın amaçları; (1) 65 yaş ve üstü hastalarda femur boyun kırığı sonrası mortaliteyi etkileyen faktörleri belirlemek, (2) protez tipine (unipolar veya bipolar) göre hastaların mortalite oranlarını, radyolojik bulgularını ve fonksiyonel sonuçlarını karşılaştırmak, (3) bipolar protezlerde iç taşıyıcı yüzey hareketinin sebatını değerlendirmektir. Çalışma Tasarımı: Retrospektif karşılaştırmalı çalışma Yöntemler: Çalışmamıza hemiartroplasti ameliyatı yapılan 65 yaş ve üstü toplam 144 hasta dâhil edildi. Hastaları unipolar ve bipolar protez grupları olarak sınıflandırdık. Mortaliteyi etkileyen faktörleri ortaya koymak için hasta dosyalarından yaş, cinsiyet, cerrahi bekleme süresi ve American Society of Anesthesiologists (ASA) skorları belirlendi. Sağ olan hastaların Barthel günlük yaşam aktivite, Harris kalça ve asetabuler erozyon skorları hesaplandı ve radyografilerle bipolar baş hareketi incelendi. Bulgular: Bir yıllık mortalite oranı % 31.94 hesaplandı. Yaşın ≥75 olması (p=0.029), erkek cinsiyet (p=0.048) ve cerrahi bekleme süresinin ≥6 gün olması (p=0.004) artmış mortalite ile ilişkili hasta karakterleriydi. İki grup arasında cinsiyet, yaş, ASA skoru, cerrahi bekleme süresi, mortalite, Barthel, Harris ve asetabulum skorları arasında anlamlı fark yoktu. Her iki gruptan yirmişer hasta son kontrol için başvurdu. Bipolar baş hareketi bu hastaların % 33.3'ünde mevcuttu. Onlar düşük Barthel ve Harris skorları olan inaktif hastalardı. Sonuç: Bipolar baş hareketi inaktif hastalarda korunmuş olsa da, bunun zorlukla yürüyebilen hastalar için bir avantaj sağlamadığını düşünmekteyiz. Bu çalışmada erkek hastalar, 75 yaş ve üstü olanlar, cerrahi bekleme süresi ≥6 gün olanlar yüksek mortalite riskine sahipti. Çok değişkenli analizlerde anlamlı bulunmamasına rağmen yüksek ASA skoru (≥3) da artmış mortalite riski ile ilişkiliydi. Her üç hastadan birinin ameliyat sonrası ilk yılda öldüğü düşünüldüğünde, bu hastaların olabildiğince erken zamanda ameliyat edilmesi gerektiğini ve pahalı bipolar protezin hasta karakterleri dikkate alınarak seçilmiş hastalarda kullanılması gerektiğini düşünmekteyiz.

Keywords

• Femoral neck fracture, mortality, hemiarthroplasty

Bipolar or Unipolar Hemiarthroplasty after Femoral Neck Fracture in the Geriatric Population

Öz

Kaynakça

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