J Arthroplasty. 2023 Jul 14:S0883-5403(23)00743-X. doi: 10.1016/j.arth.2023.07.006. Online ahead of print.
ABSTRACT
BACKGROUND: Hemiarthroplasty (HA) for hip fractures can be performed with an unipolar or bipolar head.We describe the use of unipolar and bipolar HA after a hip fracture in the Netherlands and determined revision rates and risk factors.
METHODS: All HAs for an acute hip fracture registered in the Dutch Arthroplasty Register (LROI) during 2007 to 2021 were included; 44,127(88%) unipolar and 6,013(12%) bipolar HA. Competing risk survival analyses were performed with revision for any reason as endpoint. Multivariable Cox regression analyses were performed adjusted for patient and surgery related factors.
RESULTS: The 1, 5, and 10 year revision rates were comparable for unipolar and bipolar HA. Cox regression analysis showed a Hazard Ratio of 1.2 (95% confidence interval (CI) 1.0 to 1.4)) after adjustment for confounders for bipolar heads. In cases of a cemented stem the 1-year cumulative incidence of revision was lower (1.5% (CI 1.4 to 1.7%) compared to uncemented stems (2.4% (CI 2.1 to 2.7%); uncemented stems showed higher risks for revision after adjustment compared to cemented stems (HR1.4 (CI 1.2 to 1.5)). The anterior, antero-lateral and straight-lateral approach showed lower risk for revision compared to the postero-lateral approach.
CONCLUSION: The revision rate for bipolar HA and unipolar HA was comparable. However, after adjustment for potential confounders the risk for revision showed an estimated 20% increased revision risk for bipolar heads, although not statistically significant. For both head types, the risk for revision was significantly higher when an uncemented stem was chosen or the postero-lateral approach was used.
PMID:37454950 | DOI:10.1016/j.arth.2023.07.006
