Unipolar Hip Hemiarthroplasty in Geriatric Patients: A Prospective Study and Analysis of Clinical and Radiological Outcomes

Joe Ghanimeh; Ibrahim Abusaq; Guillaume Villatte; Stéphane Descamps; Stéphane Boisgard; Roger Erivan

doi:10.1177/21514593241228670

Unipolar Hip Hemiarthroplasty in Geriatric Patients: A Prospective Study and Analysis of Clinical and Radiological Outcomes

Geriatr Orthop Surg Rehabil. 2024 Jan 28:15:21514593241228670. doi: 10.1177/21514593241228670. eCollection 2024.

Authors

Joe Ghanimeh¹, Ibrahim Abusaq^{2

3}, Guillaume Villatte², Stéphane Descamps², Stéphane Boisgard², Roger Erivan²

Affiliations

¹ Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon.
² CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, Clermont-Ferrand, France.
³ Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, Clermont-Ferrand, France.

Abstract

Introduction: Femoral neck fractures (FNF) in the geriatric population are commonly treated with hip replacement procedures, such as total hip arthroplasty, unipolar hip hemiarthroplasty (UHA), and bipolar hip hemiarthroplasty (BHA). The optimal treatment remains controversial, considering outcomes and cost-effectiveness, with UHA often being cheaper. This prospective observational study aims to evaluate UHA's clinical and radiological outcomes, safety, and survivorship compared to existing literature.

Methods: We followed 90 elderly patients who underwent UHA following FNF. We assessed patients using the Parker score before and after surgery, as well as Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) scores postoperatively. All complications, acetabular erosions and heterotopic ossifications (HO), were documented.

Results: One year post-surgery, 26.7% of patients had passed away, mostly due to declining general health status. Systemic complications occurred in 14.4% of cases, with a 1.1% rate of deep surgical site infections. A single dislocation resulted from excessive stem anteversion. UHA implant survival rate was 97.8% after 4 years. The Parker score remained stable, and HHS at 6 and 12 months was 71.5 ± 12.9 and 70.9 ± 11.8, respectively, while PMA score was 14.3 ± 2.4 and 14.5 ± 2.1, respectively. Five hips showed Baker I acetabular wear. HO were noted as Brooker I in 12 patients, II in 4 patients, and IV in 1 patient.

Discussion: UHA exhibited comparable systemic complication rates, implant survivorship, and dislocation rates to those in the literature for both UHA and BHA. The deep surgical site infection rate was lower than reported for BHA. Patients' functional and mental abilities did not decline based on clinical scores. Acetabular wear in UHA was similar to its bipolar counterpart, while HO were only minor findings with no clinical implications.

Conclusion: In elderly patients, UHA demonstrated clinical and radiological outcomes similar to BHA in existing literature. UHA may represent a cost-effective alternative for patients with limited life expectancy.

Keywords: Harris Hip Score; Parker score; acetabular erosion; cost-effectiveness of unipolar hip hemiarthroplasty; elderly patients; femoral neck fracture; unipolar hip hemiarthroplasty in the elderly.