Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence?

Abstract

This editorial reviews and summarises the current evidence (meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach, two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component, three recent meta-analyses and one Cochrane review have found that while unipolar hemi-arthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up (up to 1 year), there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome, complication profile, functional outcome and acetabular erosion rates at longer-term follow-up (2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis, unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique, three recent meta-analyses and one Cochrane Review have found that, while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties, cemented prostheses have lower rates of implant-related complications (particularly peri-prosthetic femoral fracture) and improved post-operative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality, cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure, one recent meta-analysis has found that, while staples can result in a quicker closure time, there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore, either suture or staple wound closure techniques appear equally appropriate for hip hemi-arthroplasty procedures.

Keywords: Hemi-arthroplasty, Prosthesis, Stem, Head, Hip, Femoral, Neck, Fracture, Cement

Core tip: From the current evidence on hip hemi-arthroplasty, the following conclusions can be drawn: posterior approaches are associated with higher rates of dislocation and should be avoided; there is no significant difference between unipolar and bipolar hemi-arthroplasty for surgical outcome, complication profile, functional outcome and long-term acetabular-erosion rates, therefore unipolar hemi-arthroplasty, the cheaper prosthesis, is the recommended option; cemented hemi-arthroplasty, the recommended option, has lower rates of implant-related complications and residual thigh pain compared to uncemented hemi-arthroplasty, with no significant difference in medical complications or mortality; there is no significant difference in wound-infections rates or healing outcomes between staples and sutures.