Title: Comparative Outcomes of Total Hip Arthroplasty and Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures: A Retrospective Analysis

Title: Comparative Outcomes of Total Hip Arthroplasty and Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures: A Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Title: Comparative Outcomes of Total Hip Arthroplasty and Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures: A Retrospective Analysis Dr.Behnam Haghpanah, Dr.Ehsan Taheri, Omid Salimi, Shakiba Seifi, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4886633/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Femoral neck fractures, particularly prevalent among the elderly, demand timely and appropriate treatment due to high costs and the potential for severe complications. Selecting the correct treatment method is essential to prevent long-term issues such as dislocation and the need for reoperation. This study compares the outcomes of total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA) in treating femoral neck fractures. This retrospective, applied, observational, and descriptive-analytical study was conducted on 48 patients (24 in the THA group and 24 in the BHA group). Patient information was obtained from the surgical archives of Shariati Hospital in 2020–2021. During a telephone call, patients were asked questions from the Oxford Hip Scoring Questionnaire. Data were analyzed using the chi-square test, and significance was tested. Results are presented quantitatively. Results showed that patients who underwent total hip arthroplasty scored an average of 7.5 points higher than those who had bipolar hemiarthroplasty, a statistically significant difference (p < 0.05). This suggests that total arthroplasty may offer better overall performance and outcomes in terms of pain reduction and joint efficiency for patients over 50 years old. The superiority of total arthroplasty was observed across all age groups, with the most pronounced difference in the 60–69 age range (14.43 points), followed by the 50–59 age group (2.15 points), and the smallest difference in patients 70 years and older (1.38 points). These findings indicate that total hip arthroplasty may be particularly beneficial for patients between 50 and 69 years old, while the advantage becomes less pronounced in patients 70 years and older. Individual patient factors, including comorbidities and activity levels, should guide the choice between THA and BHA. Further research with larger sample sizes and extended follow-up periods is necessary to confirm these results and inform optimal clinical decision-making for treating femoral neck fractures. Total hip arthroplasty bipolar hip hemiarthroplasty femoral neck fracture elderly patients surgical outcomes patient satisfaction quality of life limb length discrepancy postoperative complications reoperation Introduction Fractures of the femoral neck are a common and serious injury among the elderly, associated with significant morbidity and mortality.( 1 ) The FNF in the elderly has drastically increased over the past few decades and is projected to reach 6.3 million by 2050.( 2 ) This surge places a significant burden on global healthcare systems.( 3 ) As life expectancy rises, the frequency of hip fractures continues to grow, emphasizing the need for effective treatment strategies.( 4 ) These fractures present a major challenge to orthopedic surgeons and are a subject of ongoing research regarding optimal treatment methods and outcomes. Typically, patients with femoral neck fractures are elderly, have severe osteoporosis, and suffer from multiple comorbidities.( 5 – 7 ) The primary treatment goal is to enable early ambulation in older patients (aged over 60), which is often achieved through surgical interventions such as bipolar prosthesis or total hip replacement (THR). aiming to mitigate complications associated with prolonged immobilization.( 3 , 8 – 11 ) Regarding treatment options for displaced FNFs, surgical approaches include internal fixation (not recommended for elderly patients) and arthroplasty.( 12 – 15 ) Hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely used methods for hip replacement after FNF. While some evidence suggests that THA results in better functional outcomes( 16 ), HA has advantages such as reduced dislocation rates, simpler surgery, shorter operation time, less blood loss, and lower initial costs.( 17 ) In HA, the prosthesis and acetabulum can be articulated using either a unipolar or bipolar prosthesis. Recent studies indicate that bipolar HA (BHA) provides favorable outcomes for elderly patients with displaced FNFs. BHA shows predictable medium- and long-term results, even compared to internal fixation or unipolar HA( 12 , 18 , 19 ). Additionally, BHA has a delayed onset of acetabular erosion compared to unipolar HA( 19 , 20 ). National registry data support continued BHA use for displaced FNFs in the elderly, suggesting it should be the preferred treatment( 21 ). Elderly patients receiving BHA may also have better survival outcomes than those receiving unipolar HA( 22 ). Furthermore, uncemented BHA appears beneficial for fit, physiologically young elderly patients with FNFs( 23 ). However, clinical opinions on recommending BHA versus THA vary.( 24 – 26 ) This study aims to compare the short-term outcomes of bipolar hemiarthroplasty (BHA) and total hip Arthroplasty (THA) for managing displaced femoral neck fractures in the elderly. Utilizing the Oxford Hip Score, and assessments of limb size perceived discrepancy and dislocation rates post-surgery, this research seeks to provide comprehensive insights into the best approach for maximizing patient mobility and overall outcomes. Recently, the focus in orthopaedic surgery outcome assessments has shifted from the success or failure of implants to patient satisfaction and quality of life. The Oxford Hip Score (OHS) is a patient-centered questionnaire designed to evaluate functional ability and pain from the patient's perspective. This concise, twelve-item questionnaire is intended for patients undergoing total hip replacement (THR) and is widely cited in orthopedic literature. The OHS has proven to be highly sensitive to changes in patients undergoing primary and shows a strong correlation with patient satisfaction. ( 27 , 28 ) By examining these functional outcomes, the study aims to enhance the existing knowledge on treatment options for femoral neck fractures and inform clinical decision-making. Method This study is a retrospective, observational, and analytical descriptive study presenting quantitative results. The primary objective was to assess the quality of life of these individuals, while secondary objectives included investigating the incidence of joint dislocation post-operation and the presence of a perceived size difference between the lower limbs. Initially, 78 patients who underwent Total Hip Arthroplasty (THA) or Bipolar Hemiarthroplasty (BHA) in 2020 and 2021 were considered for the study. Of these, 62 met the inclusion criteria. Ultimately, 48 patients were included in the study, 24 undergoing BHA and 24 undergoing THA. The study population included individuals over 50 years of age who underwent BHA or THA at Isfahan Shariati Hospital in 2020–2021 due to femoral neck fractures. Participants were selected based on specific inclusion and exclusion criteria to ensure a robust and representative sample. The study evaluated postoperative outcomes using the Oxford Hip Score (OHS). This 12-item questionnaire assesses pain and joint functionality and is suitable for telephonic administration. The OHS has a scoring range from 12 to 60, with higher scores indicating better outcomes. Additional questions addressed reoperation, dislocation, and perceived limb length discrepancy. Data were collected through structured telephone interviews using the OHS. Participants were also asked about post-surgery reoperations, dislocations, and perceived limb length discrepancies. Data were analyzed using SPSS software, and descriptive statistics summarized participant demographics and outcome measures. The OHS scores and binary outcomes for reoperation, dislocation, and limb length discrepancy were compared between the BHA and THA groups using appropriate statistical tests. 50–59 years: 3 people Bipolar Hip Arthroplasty Men: 14 patients Percentage: 58.5% of bipolar hip arthroplasty group Bipolar Hip Arthroplasty: 24 patients Percentage: 50% of total participants Total patients: 48 Male: 58.5% Female: 41.5% 60–69 years: 7 people 70 years and above: 4 people 50–59 years: 3 people Bipolar Hip Arthroplasty Women : 10 patients Percentage: 41.5% of bipolar hip arthroplasty group 60–69 years: 4 people 70 years and above: 3 people 50–59 years: 5 people Total Hip Arthroplasty Men : 14 patients Percentage: 58.5% of total hip arthroplasty group Total Hip Arthroplasty : 24 patients Percentage: 50% of total participants 60–69 years: 4 people 70 years and above: 5 people 50–59 years: 3 people Total Hip Arthroplasty Women : 10 patients Percentage: 41.5% of total hip arthroplasty group 60–69 years: 3 people 70 years and above: 4 people Results The mean age of the study participants was 66.54 years, with the youngest participant being 50 years old and the oldest 83 years old. The mean age of patients undergoing BHA was 66.12 years, and for those undergoing THA, it was 66.95 years. Variable n Average Age 24 66/12 24 66/95 Post-operative Satisfaction Scores Table 1: Differences in Mean Scores of the Oxford Questionnaire Across Age Groups Over 50 Years in Total and Bipolar Hip Arthroplasty The results demonstrated that patients who underwent total hip arthroplasty (THA) scored an average of 7.5 points higher than those who had bipolar hemiarthroplasty (BHA), indicating a statistically significant difference (p < 0.05). This suggests that THA may provide better overall outcomes in terms of pain reduction and joint efficiency for patients over 50 years old. The superiority of THA was evident across all age groups, with the largest difference seen in the 60–69 age range (14.43 points), followed by the 50–59 age group (2.15 points), and the smallest difference in patients 70 years and older (1.38 points). These findings imply that THA may be particularly advantageous for patients between 50 and 69 years old, while the benefit diminishes in patients 70 years and older. The choice between THA and BHA should be guided by individual patient factors, such as comorbidities and activity levels. Table 2: Statistical Difference in Mean OHS Questionnaire Scores between Study Groups This table examines the statistical difference in mean OHS scores between the two study groups. Type of surgery Mean OHS questionnaire score (all patients) Mean OHS score for patients aged 50–59 years Mean OHS score for patients aged 60–69 years Mean OHS score for patients aged 70 years and above Bipolar hip hemiarthroplasty 39/5 44/83 39/27 40/42 Total hip arthroplasty 47 46/98 53/7 41/8 Perceived Limb Length Discrepancy The data analysis revealed that the p-value for the perceived limb length discrepancy between the two surgical methods exceeded the threshold of 0.05, indicating that there is no statistically significant difference in perceived limb discrepancy between total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA). however, It is important to note that factors such as the location of the fracture, the type of trauma, and the specifics of the surgical procedure could influence these outcomes. While these factors are relevant, they are beyond the scope of the current study and warrant further investigation in future research. Table 3: Difference in Perceived Limb Size Discrepancy between the Two Surgical Procedures This table compares the incidence of perceived limb size discrepancy as reported by patients for the two surgical procedures in different age groups. Type of surgery Incidence of perceived limb length discrepancy (all patients) Incidence of perceived limb length discrepancy, in the 50 to 59 age group Incidence of perceived limb length discrepancy, in the 60 to 69 age group Incidence of perceived limb length discrepancy, in the 70 years and above age group Incidence ratio of limb size discrepancy by group P value BHA 4/24 2 1 1 4 0/15151 THA 7/24 4 1 2 7 Incidence of Post-Surgery Dislocation The results indicate that six individuals in the study experienced hip joint dislocations. Of these, four had undergone bipolar hip arthroplasty, and two had received total hip arthroplasty. The results showed that the p-value was greater than 0.05, suggesting no statistically significant difference in the incidence of dislocation between the two surgical procedures. This analysis underscores the need for further research to investigate potential factors that may influence dislocation rates in different hip arthroplasty techniques. Table 4: Incidence of Post-Operative Hip Joint Dislocation for Total and Bipolar Arthroplasty Type of surgery Post-operative joint dislocation incidence (all patients) Post-operative joint dislocation incidence(50–59) Post-operative joint dislocation incidence(60–69) Post-operative joint dislocation incidence(70 and above) Post-operative dislocation incidence ratio P value BHA 4 0 2 2 4/24 0/19215 THA 2 0 0 2 2/24 According to the table below, the only notable difference was observed in the Post-operative Satisfaction Scores between the two types of surgery. Table 5: Comparative Outcomes Between Patients Undergoing Bipolar Hemiarthroplasty (BHA) and Total Hip Arthroplasty (THA):Perceived Limb Length Discrepancy, Postoperative Dislocation Rates, and Oxford Hip Questionnaire Scores Measure BHA THA P-value Number of Patients 24 24 - Mean Age (years) 66.12 66.95 - Oxford Hip Score 39.5 47 0.05 Post-Surgery Dislocation 4 2 > 0.05 Discussion Upon analyzing the data, it was evident that the quality of life and patient satisfaction were significantly higher in the THA group compared to the BHA group. This finding aligns with several prior studies and highlights the potential benefits of THA in enhancing patient outcomes. Lewis et al. (2019) conducted a meta-analysis and systematic review of 1,364 cases of femoral head fractures, concluding that THA was superior in terms of reoperation risk, Harris Hip Score, and overall quality of life. While their analysis highlighted a higher complication risk for BHA within the first four years post-surgery, it diminished over time. Our findings, limited to a follow-up period of 1–2 years, support the notion that THA provides better quality of life and patient satisfaction without significant differences in dislocation rates, suggesting the need for longer-term studies to fully capture the complication profiles of both procedures.( 29 ) Ekhtiary (2020) reviewed 16 studies encompassing 3,084 femoral neck fracture cases and reported marginally higher quality of life scores in the THA group, with no significant differences in dislocation rates or other postoperative complications. This corroborates our results, reinforcing THA's superiority in enhancing patient satisfaction and quality of life.( 30 ) Suarez et al. (2020), in a retrospective analysis of 16,213 cases, found that THA was associated with fewer complications over a shorter follow-up period compared to BHA. Their findings support our conclusion that THA is preferable for improving patient outcomes. Additionally, Teng et al. (2020) in a systematic meta-analysis of 25 studies, concluded that THA outperformed BHA in terms of quality of life, Harris Hip Score within 1–5 years post-operation, and reduced risk of acetabular erosion. However, BHA demonstrated advantages in terms of shorter hospitalization duration, reduced bleeding, and shorter operation time, reflecting a balanced consideration of both procedures based on specific patient needs and surgical contexts.( 31 ) Lee and Lu (2021) compared 413,140 hemiarthroplasty cases with 44,973 THA cases, finding significantly lower intraoperative bleeding in the BHA group but longer hospitalization durations and higher risks of pneumonia and kidney failure. Their review also suggested a lower dislocation risk with BHA, consistent with other studies and our findings. This highlights the importance of weighing the benefits of reduced operative complications against the potential for improved long-term outcomes with THA.( 32 ) Su et al. (2023) conducted a meta-analysis utilizing the European Quality of Life 5-Dimension Questionnaire (EU-5Q) to measure health-related quality of life (HRQoL) after hip arthroplasty in elderly patients. Their analysis included four RCTs, two cohort studies, three case-control trials, and three cross-sectional surveys, encompassing a total of 651 elderly patients. They found that THA resulted in significantly higher HRQoL scores compared to hemiarthroplasty (OR = 0.05; 95% CI, 0.02–0.08; P = 0.002), suggesting that THA may be more beneficial for elderly patients in terms of overall quality of life.( 33 ) Okike et al. (2023) examined a U.S. hip fracture registry to compare the revision risks associated with unipolar hemiarthroplasty, bipolar hemiarthroplasty, and THA. Their multivariable Cox proportional hazards analysis revealed that both unipolar and bipolar hemiarthroplasty had higher revision risks compared to THA, particularly in patients aged 60 to 79 years and those with an ASA classification of I or II. This finding aligns with our results, where THA participants reported higher satisfaction and no significant differences in dislocation rates compared to BHA.( 34 ) Another study by Tohidi et al. (2024) utilized a propensity-score-matched cohort to compare the effectiveness of THA and hemiarthroplasty for displaced FNFs. Their results indicated that although both groups had similar revision and readmission rates, THA patients had higher dislocation rates but lower mortality rates. These findings emphasize the importance of considering patient-specific factors such as age, comorbidities, and overall health status when choosing between THA and hemiarthroplasty.( 35 ) It is important to note that a difference in size between the two lower limbs is relatively common in both bipolar and total hip arthroplasty procedures. According to the literature, limb length discrepancy can cause pain, limping, and neuropathy. However, perceived LLD(limb length discrepancy) has been reported in the range of 20–32% of patients and LLD is consistently perceived when the shortening is greater than 10 mm and the lengthening is more than 6 mm. ( 36 ) There is a consensus among medical professionals that when LLD exceeds 1.5 cm, it can lead to several issues including lower back pain, abnormal gait patterns, and overall patient dissatisfaction.( 37 ) Furthermore, some researchers have noted that even minor disparities in leg length following THA can have adverse effects, particularly in terms of limping and pain experienced by patients.( 38 ) Anyway, Our study revealed no significant difference between the two methods regarding perceived limb length discrepancy (LLD). Dislocation following surgery is a significant complication in both total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA). The complications and associated costs of dislocation are substantial for both the healthcare system and the patient. However, the literature presents conflicting evidence regarding the comparative rates of dislocation between THA and BHA. Contrary to Fan et al. (2012), who recommended BHA for elderly patients with unstable intertrochanteric fractures due to lower dislocation rates and reduced operative duration, our study found no significant difference in the incidence of postoperative dislocations between the THA and BHA groups. This discrepancy may be attributed to differences in the patient demographics and fracture types considered in Fan et al.'s research.( 39 ) In conclusion , our study reinforces the existing body of evidence that THA generally leads to higher patient satisfaction and quality of life compared to BHA for the treatment of femoral neck fractures. While both procedures exhibit comparable rates of postoperative dislocation and limb length discrepancy, the choice between THA and BHA should consider individual patient factors, including comorbidities, activity levels, and specific surgical risks. Further research with larger sample sizes and extended follow-up periods is warranted to deepen our understanding of the long-term outcomes and optimize treatment strategies for this patient population. Research Limitations This study was limited by a small sample size due to the relatively low number of femoral neck fracture patients referred to Shariati Hospital. The use of a telephone questionnaire, necessary due to the time-consuming nature of in-person examinations, restricted the ability to assess aspects such as joint range of motion post-surgery. Additionally, the inability to directly measure limb length discrepancy relied on patients' subjective assessments, potentially increasing the error rate. Suggestions for Further Studies Most recent studies and meta-analyses published in reputable journals favor THA over BHA, though few have considered specific age ranges for this preference. Some studies have rejected the preference for patients over 80 years old. Further research is needed on complications, postoperative infections, dislocation, and limb length discrepancy. Future studies should investigate the preferred method for different types of femoral neck fractures and consider factors such as prosthesis type and surgical cement. Additionally, research should examine risk factors for joint dislocation to provide a more comprehensive understanding. Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the committee of Islamic Azad University, Najafabad Branch with this approval statement: the project was found to be in accordance to the ethical principles and the national norms and standards for conducting Medical Research in Iran. (approval number: [ IR.IAU.NAJAFABAD.REC.1401,134 ] as the Research Ethics Committee's Certificate is uploaded in the related files). The information related to each participant was kept confidential, with checklists coded and provided to individuals if needed. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki, and no coercion was imposed on participants. Subjects entered the study after receiving prepared written consent forms, and those who did not consent were assured that their information would not be disclosed. Consent for publication All authors have read and approved the final manuscript and consent to its publication. Informed consent was obtained from all participants involved in the study, who were made aware of the study's purpose and their rights regarding participation and publication. The confidentiality of participants was maintained throughout the research, and no identifying information is included in the manuscript. The study was conducted in accordance with ethical standards, and consent for publication was obtained as per the guidelines of the Ethics Committee of Islamic Azad University, Najafabad Branch. This format ensures clarity and compliance with the journal's requirements. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding We did not receive any funding or financial support for this study. Author’s Contributions Dr. Behnam Haghpanah conceived of the presented idea. Ali Sohrabi, Omid Salimi, and Dr. Ehsan Taheri wrote the manuscript with consultation from all authors. Ali Sohrabi, Omid Salimi, and Shakiba Seifi conceived the study and were in charge of the overall direction and planning. With the help of Ali Khalifehsoltani and Kousha Heidarpour, data were collected through the Hospital information system and by interviewing patients. Alireza Amini filled out the forms. Ali Sohrabi and Dr. Behnam Haghpanah carried out the statistical analysis. All authors discussed the results and commented on the manuscript. Acknowledgments We would like to express our gratitude to the staff of Shariati Hospital for their support and assistance in data collection and management. We also thank the participants of this study for their willingness to share their experiences and provide valuable information that contributed to this research. Additionally, we acknowledge the contributions of the Clinical Research Development Center at Najafabad Branch, Islamic Azad University, for their resources and support throughout this study. Finally, we appreciate the guidance and feedback from our colleagues and mentors, who were instrumental in refining our research and manuscript. 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Taheri","email":"","orcid":"","institution":"Medical doctor, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":false,"prefix":"Dr.","firstName":"Ehsan","middleName":"","lastName":"Taheri","suffix":""},{"id":346909119,"identity":"9cebba97-80ee-4414-ae96-97ea43d185b4","order_by":2,"name":"Omid Salimi","email":"","orcid":"","institution":"Medical student, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":false,"prefix":"","firstName":"Omid","middleName":"","lastName":"Salimi","suffix":""},{"id":346909120,"identity":"66dd44bd-b65a-43bb-9afb-24c8bc93c10d","order_by":3,"name":"Shakiba Seifi","email":"","orcid":"","institution":"Medical student, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":false,"prefix":"","firstName":"Shakiba","middleName":"","lastName":"Seifi","suffix":""},{"id":346909121,"identity":"28f34fba-aa4d-4278-bb3b-a7d97646f1da","order_by":4,"name":"Alireza Amini","email":"","orcid":"","institution":"Medical student, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Amini","suffix":""},{"id":346909122,"identity":"39ef06e4-e228-4a0e-b56b-f8c16252dcc9","order_by":5,"name":"Kousha Heidarpour","email":"","orcid":"","institution":"Medical student, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":false,"prefix":"","firstName":"Kousha","middleName":"","lastName":"Heidarpour","suffix":""},{"id":346909123,"identity":"6de89dae-6cee-4908-8d04-f952da888a80","order_by":6,"name":"Ali Khalifehsoltany","email":"","orcid":"","institution":"Medical student, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Khalifehsoltany","suffix":""},{"id":346909124,"identity":"cd882997-1d06-4410-82eb-22252f12dd12","order_by":7,"name":"Ali Sohrabi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYDACdsYGBiBiMGBmYDj4oUJCDiR44AE+LcwILYyHJc7YGIO1JODVAsRgLUDmAd62tMQGkCg+LfzNzM0fPu64J2/ODjRc4szh9Plhhx8CbbGT023ArkXiMGOb5MwzxYY7m4FaCioO5268nWYA1JJsbHYAhzVALcy8bQmMGw5DbMndODsBpOVA4jYcWuQPMzZ/BmqxB2vhbTucbjg7/QNeLQaHGRukgVoSoVrSEuSlc/DbYgj2S1tC8s5mxgZQIBtukM4pOJBggNsvcsfbH3/42JZgu53/8OGPwKiUl5+dvvnDhwo7OZzeRwBQ7ICcClZpQFA5EpBvIEX1KBgFo2AUjAQAAE7SaGHIzIw2AAAAAElFTkSuQmCC","orcid":"","institution":"Medical student, Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad","correspondingAuthor":true,"prefix":"","firstName":"Ali","middleName":"","lastName":"Sohrabi","suffix":""}],"badges":[],"createdAt":"2024-08-09 11:12:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4886633/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4886633/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68162842,"identity":"bbe54de9-1fe7-48b4-848a-4fc920cf5f96","added_by":"auto","created_at":"2024-11-04 09:17:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":657732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4886633/v1/e61596f4-e2d9-42ee-aa2d-13533db3a922.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Title: Comparative Outcomes of Total Hip Arthroplasty and Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures: A Retrospective Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFractures of the femoral neck are a common and serious injury among the elderly, associated with significant morbidity and mortality.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The FNF in the elderly has drastically increased over the past few decades and is projected to reach 6.3\u0026nbsp;million by 2050.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) This surge places a significant burden on global healthcare systems.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) As life expectancy rises, the frequency of hip fractures continues to grow, emphasizing the need for effective treatment strategies.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) These fractures present a major challenge to orthopedic surgeons and are a subject of ongoing research regarding optimal treatment methods and outcomes. Typically, patients with femoral neck fractures are elderly, have severe osteoporosis, and suffer from multiple comorbidities.(\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The primary treatment goal is to enable early ambulation in older patients (aged over 60), which is often achieved through surgical interventions such as bipolar prosthesis or total hip replacement (THR). aiming to mitigate complications associated with prolonged immobilization.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eRegarding treatment options for displaced FNFs, surgical approaches include internal fixation (not recommended for elderly patients) and arthroplasty.(\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely used methods for hip replacement after FNF. While some evidence suggests that THA results in better functional outcomes(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), HA has advantages such as reduced dislocation rates, simpler surgery, shorter operation time, less blood loss, and lower initial costs.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn HA, the prosthesis and acetabulum can be articulated using either a unipolar or bipolar prosthesis. Recent studies indicate that bipolar HA (BHA) provides favorable outcomes for elderly patients with displaced FNFs. BHA shows predictable medium- and long-term results, even compared to internal fixation or unipolar HA(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Additionally, BHA has a delayed onset of acetabular erosion compared to unipolar HA(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). National registry data support continued BHA use for displaced FNFs in the elderly, suggesting it should be the preferred treatment(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Elderly patients receiving BHA may also have better survival outcomes than those receiving unipolar HA(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Furthermore, uncemented BHA appears beneficial for fit, physiologically young elderly patients with FNFs(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, clinical opinions on recommending BHA versus THA vary.(\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e–\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis study aims to compare the short-term outcomes of bipolar hemiarthroplasty (BHA) and total hip Arthroplasty (THA) for managing displaced femoral neck fractures in the elderly. Utilizing the Oxford Hip Score, and assessments of limb size perceived discrepancy and dislocation rates post-surgery, this research seeks to provide comprehensive insights into the best approach for maximizing patient mobility and overall outcomes.\u003c/p\u003e \u003cp\u003eRecently, the focus in orthopaedic surgery outcome assessments has shifted from the success or failure of implants to patient satisfaction and quality of life. The Oxford Hip Score (OHS) is a patient-centered questionnaire designed to evaluate functional ability and pain from the patient's perspective. This concise, twelve-item questionnaire is intended for patients undergoing total hip replacement (THR) and is widely cited in orthopedic literature. The OHS has proven to be highly sensitive to changes in patients undergoing primary and shows a strong correlation with patient satisfaction. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBy examining these functional outcomes, the study aims to enhance the existing knowledge on treatment options for femoral neck fractures and inform clinical decision-making.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis study is a retrospective, observational, and analytical descriptive study presenting quantitative results. The primary objective was to assess the quality of life of these individuals, while secondary objectives included investigating the incidence of joint dislocation post-operation and the presence of a perceived size difference between the lower limbs.\u003c/p\u003e\u003cp\u003eInitially, 78 patients who underwent Total Hip Arthroplasty (THA) or Bipolar Hemiarthroplasty (BHA) in 2020 and 2021 were considered for the study. Of these, 62 met the inclusion criteria. Ultimately, 48 patients were included in the study, 24 undergoing BHA and 24 undergoing THA. The study population included individuals over 50 years of age who underwent BHA or THA at Isfahan Shariati Hospital in 2020–2021 due to femoral neck fractures. Participants were selected based on specific inclusion and exclusion criteria to ensure a robust and representative sample.\u003c/p\u003e\u003cp\u003eThe study evaluated postoperative outcomes using the Oxford Hip Score (OHS). This 12-item questionnaire assesses pain and joint functionality and is suitable for telephonic administration. The OHS has a scoring range from 12 to 60, with higher scores indicating better outcomes. Additional questions addressed reoperation, dislocation, and perceived limb length discrepancy.\u003c/p\u003e\u003cp\u003eData were collected through structured telephone interviews using the OHS. Participants were also asked about post-surgery reoperations, dislocations, and perceived limb length discrepancies. Data were analyzed using SPSS software, and descriptive statistics summarized participant demographics and outcome measures. The OHS scores and binary outcomes for reoperation, dislocation, and limb length discrepancy were compared between the BHA and THA groups using appropriate statistical tests.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50–59 years: 3 people\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBipolar Hip Arthroplasty\u003c/p\u003e \u003cp\u003eMen: 14 patients\u003c/p\u003e \u003cp\u003ePercentage: 58.5% of bipolar hip arthroplasty group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eBipolar Hip Arthroplasty: 24 patients\u003c/p\u003e \u003cp\u003ePercentage: 50% of total participants\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"11\" rowspan=\"12\"\u003e \u003cp\u003eTotal patients: 48\u003c/p\u003e \u003cp\u003eMale: 58.5%\u003c/p\u003e \u003cp\u003eFemale: 41.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60–69 years: 7 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 years and above: 4 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50–59 years: 3 people\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eBipolar Hip Arthroplasty Women\u003c/b\u003e: 10 patients\u003c/p\u003e \u003cp\u003ePercentage: 41.5% of bipolar hip arthroplasty group\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60–69 years: 4 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 years and above: 3 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50–59 years: 5 people\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTotal Hip Arthroplasty Men\u003c/b\u003e: 14 patients\u003c/p\u003e \u003cp\u003ePercentage: 58.5% of total hip arthroplasty group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eTotal Hip Arthroplasty\u003c/b\u003e: 24 patients\u003c/p\u003e \u003cp\u003ePercentage: 50% of total participants\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60–69 years: 4 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 years and above: 5 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50–59 years: 3 people\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTotal Hip Arthroplasty Women\u003c/b\u003e: 10 patients\u003c/p\u003e \u003cp\u003ePercentage: 41.5% of total hip arthroplasty group\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60–69 years: 3 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 years and above: 4 people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the study participants was 66.54 years, with the youngest participant being 50 years old and the oldest 83 years old. The mean age of patients undergoing BHA was 66.12 years, and for those undergoing THA, it was 66.95 years.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66/12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66/95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003ePost-operative Satisfaction Scores\u003c/p\u003e\n\u003cp\u003eTable 1: Differences in Mean Scores of the Oxford Questionnaire Across Age Groups Over 50 Years in Total and Bipolar Hip Arthroplasty\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" style=\"width: 958px;\" width=\"958\" height=\"562\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThe results demonstrated that patients who underwent total hip arthroplasty (THA) scored an average of 7.5 points higher than those who had bipolar hemiarthroplasty (BHA), indicating a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests that THA may provide better overall outcomes in terms of pain reduction and joint efficiency for patients over 50 years old. The superiority of THA was evident across all age groups, with the largest difference seen in the 60\u0026ndash;69 age range (14.43 points), followed by the 50\u0026ndash;59 age group (2.15 points), and the smallest difference in patients 70 years and older (1.38 points). These findings imply that THA may be particularly advantageous for patients between 50 and 69 years old, while the benefit diminishes in patients 70 years and older. The choice between THA and BHA should be guided by individual patient factors, such as comorbidities and activity levels.\u003c/p\u003e\n\u003cp\u003eTable 2: Statistical Difference in Mean OHS Questionnaire Scores between Study Groups\u003c/p\u003e\n\u003cdiv align=\"\" class=\"colspec\"\u003e\u0026nbsp;This table examines the statistical difference in mean OHS scores between the two study groups.\u003c/div\u003e\n\u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean OHS questionnaire score (all patients)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean OHS score for patients aged 50\u0026ndash;59 years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean OHS score for patients aged 60\u0026ndash;69 years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean OHS score for patients aged 70 years and above\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBipolar hip hemiarthroplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44/83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39/27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40/42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal hip arthroplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46/98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41/8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003ePerceived Limb Length Discrepancy\u003c/p\u003e\n\u003cp\u003eThe data analysis revealed that the p-value for the perceived limb length discrepancy between the two surgical methods exceeded the threshold of 0.05, indicating that there is no statistically significant difference in perceived limb discrepancy between total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA). however, It is important to note that factors such as the location of the fracture, the type of trauma, and the specifics of the surgical procedure could influence these outcomes. While these factors are relevant, they are beyond the scope of the current study and warrant further investigation in future research.\u003c/p\u003e\n\u003cp\u003eTable 3: Difference in Perceived Limb Size Discrepancy between the Two Surgical Procedures\u003c/p\u003e\n\u003cp\u003eThis table compares the incidence of perceived limb size discrepancy as reported by patients for the two surgical procedures in different age groups.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence of perceived limb length discrepancy (all patients)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence of perceived limb length discrepancy, in the 50 to 59 age group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence of perceived limb length discrepancy, in the 60 to 69 age group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence of perceived limb length discrepancy, in the 70 years and above age group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence ratio of limb size discrepancy by group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0/15151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eIncidence of Post-Surgery Dislocation\u003c/p\u003e\n\u003cp\u003eThe results indicate that six individuals in the study experienced hip joint dislocations. Of these, four had undergone bipolar hip arthroplasty, and two had received total hip arthroplasty. The results showed that the p-value was greater than 0.05, suggesting no statistically significant difference in the incidence of dislocation between the two surgical procedures. This analysis underscores the need for further research to investigate potential factors that may influence dislocation rates in different hip arthroplasty techniques.\u003c/p\u003e\n\u003cp\u003eTable 4: Incidence of Post-Operative Hip Joint Dislocation for Total and Bipolar Arthroplasty\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-operative joint dislocation incidence (all patients)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-operative joint dislocation incidence(50\u0026ndash;59)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-operative joint dislocation incidence(60\u0026ndash;69)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-operative joint dislocation incidence(70 and above)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-operative dislocation incidence ratio\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0/19215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the table below, the only notable difference was observed in the Post-operative Satisfaction Scores between the two types of surgery.\u003c/p\u003e\n\u003cp\u003eTable 5: Comparative Outcomes Between Patients Undergoing Bipolar Hemiarthroplasty (BHA) and Total Hip Arthroplasty (THA):Perceived Limb Length Discrepancy, Postoperative Dislocation Rates, and Oxford Hip Questionnaire Scores \u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabf\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBHA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTHA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean Age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOxford Hip Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived Limb Length Discrepancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost-Surgery Dislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUpon analyzing the data, it was evident that the quality of life and patient satisfaction were significantly higher in the THA group compared to the BHA group. This finding aligns with several prior studies and highlights the potential benefits of THA in enhancing patient outcomes.\u003c/p\u003e \u003cp\u003eLewis et al. (2019) conducted a meta-analysis and systematic review of 1,364 cases of femoral head fractures, concluding that THA was superior in terms of reoperation risk, Harris Hip Score, and overall quality of life. While their analysis highlighted a higher complication risk for BHA within the first four years post-surgery, it diminished over time. Our findings, limited to a follow-up period of 1\u0026ndash;2 years, support the notion that THA provides better quality of life and patient satisfaction without significant differences in dislocation rates, suggesting the need for longer-term studies to fully capture the complication profiles of both procedures.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eEkhtiary (2020) reviewed 16 studies encompassing 3,084 femoral neck fracture cases and reported marginally higher quality of life scores in the THA group, with no significant differences in dislocation rates or other postoperative complications. This corroborates our results, reinforcing THA's superiority in enhancing patient satisfaction and quality of life.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSuarez et al. (2020), in a retrospective analysis of 16,213 cases, found that THA was associated with fewer complications over a shorter follow-up period compared to BHA. Their findings support our conclusion that THA is preferable for improving patient outcomes. Additionally, Teng et al. (2020) in a systematic meta-analysis of 25 studies, concluded that THA outperformed BHA in terms of quality of life, Harris Hip Score within 1\u0026ndash;5 years post-operation, and reduced risk of acetabular erosion. However, BHA demonstrated advantages in terms of shorter hospitalization duration, reduced bleeding, and shorter operation time, reflecting a balanced consideration of both procedures based on specific patient needs and surgical contexts.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eLee and Lu (2021) compared 413,140 hemiarthroplasty cases with 44,973 THA cases, finding significantly lower intraoperative bleeding in the BHA group but longer hospitalization durations and higher risks of pneumonia and kidney failure. Their review also suggested a lower dislocation risk with BHA, consistent with other studies and our findings. This highlights the importance of weighing the benefits of reduced operative complications against the potential for improved long-term outcomes with THA.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSu et al. (2023) conducted a meta-analysis utilizing the European Quality of Life 5-Dimension Questionnaire (EU-5Q) to measure health-related quality of life (HRQoL) after hip arthroplasty in elderly patients. Their analysis included four RCTs, two cohort studies, three case-control trials, and three cross-sectional surveys, encompassing a total of 651 elderly patients. They found that THA resulted in significantly higher HRQoL scores compared to hemiarthroplasty (OR\u0026thinsp;=\u0026thinsp;0.05; 95% CI, 0.02\u0026ndash;0.08; P\u0026thinsp;=\u0026thinsp;0.002), suggesting that THA may be more beneficial for elderly patients in terms of overall quality of life.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOkike et al. (2023) examined a U.S. hip fracture registry to compare the revision risks associated with unipolar hemiarthroplasty, bipolar hemiarthroplasty, and THA. Their multivariable Cox proportional hazards analysis revealed that both unipolar and bipolar hemiarthroplasty had higher revision risks compared to THA, particularly in patients aged 60 to 79 years and those with an ASA classification of I or II. This finding aligns with our results, where THA participants reported higher satisfaction and no significant differences in dislocation rates compared to BHA.(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAnother study by Tohidi et al. (2024) utilized a propensity-score-matched cohort to compare the effectiveness of THA and hemiarthroplasty for displaced FNFs. Their results indicated that although both groups had similar revision and readmission rates, THA patients had higher dislocation rates but lower mortality rates. These findings emphasize the importance of considering patient-specific factors such as age, comorbidities, and overall health status when choosing between THA and hemiarthroplasty.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt is important to note that a difference in size between the two lower limbs is relatively common in both bipolar and total hip arthroplasty procedures. According to the literature, limb length discrepancy can cause pain, limping, and neuropathy. However, perceived LLD(limb length discrepancy) has been reported in the range of 20\u0026ndash;32% of patients and LLD is consistently perceived when the shortening is greater than 10 mm and the lengthening is more than 6 mm. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) There is a consensus among medical professionals that when LLD exceeds 1.5 cm, it can lead to several issues including lower back pain, abnormal gait patterns, and overall patient dissatisfaction.(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) Furthermore, some researchers have noted that even minor disparities in leg length following THA can have adverse effects, particularly in terms of limping and pain experienced by patients.(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) Anyway, Our study revealed no significant difference between the two methods regarding perceived limb length discrepancy (LLD).\u003c/p\u003e \u003cp\u003eDislocation following surgery is a significant complication in both total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA). The complications and associated costs of dislocation are substantial for both the healthcare system and the patient. However, the literature presents conflicting evidence regarding the comparative rates of dislocation between THA and BHA. Contrary to Fan et al. (2012), who recommended BHA for elderly patients with unstable intertrochanteric fractures due to lower dislocation rates and reduced operative duration, our study found no significant difference in the incidence of postoperative dislocations between the THA and BHA groups. This discrepancy may be attributed to differences in the patient demographics and fracture types considered in Fan et al.'s research.(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn conclusion\u003c/b\u003e, our study reinforces the existing body of evidence that THA generally leads to higher patient satisfaction and quality of life compared to BHA for the treatment of femoral neck fractures. While both procedures exhibit comparable rates of postoperative dislocation and limb length discrepancy, the choice between THA and BHA should consider individual patient factors, including comorbidities, activity levels, and specific surgical risks. Further research with larger sample sizes and extended follow-up periods is warranted to deepen our understanding of the long-term outcomes and optimize treatment strategies for this patient population.\u003c/p\u003e\n\u003ch3\u003eResearch Limitations\u003c/h3\u003e\n\u003cp\u003e This study was limited by a small sample size due to the relatively low number of femoral neck fracture patients referred to Shariati Hospital. The use of a telephone questionnaire, necessary due to the time-consuming nature of in-person examinations, restricted the ability to assess aspects such as joint range of motion post-surgery. Additionally, the inability to directly measure limb length discrepancy relied on patients' subjective assessments, potentially increasing the error rate.\u003c/p\u003e\n\u003ch3\u003eSuggestions for Further Studies\u003c/h3\u003e\n\u003cp\u003eMost recent studies and meta-analyses published in reputable journals favor THA over BHA, though few have considered specific age ranges for this preference. Some studies have rejected the preference for patients over 80 years old. Further research is needed on complications, postoperative infections, dislocation, and limb length discrepancy. Future studies should investigate the preferred method for different types of femoral neck fractures and consider factors such as prosthesis type and surgical cement. Additionally, research should examine risk factors for joint dislocation to provide a more comprehensive understanding.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n\u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the committee of Islamic Azad University, Najafabad Branch with this approval statement: the project was found to be in accordance to the ethical principles and the national norms and standards for conducting Medical Research in Iran.\u003c/p\u003e\n\n\u003cp\u003e(approval number: [\u003cstrong\u003eIR.IAU.NAJAFABAD.REC.1401,134\u003c/strong\u003e] \u003cspan dir=\"RTL\"\u003e \u003c/span\u003eas the Research Ethics Committee\u0026apos;s Certificate is uploaded in the related files). The information related to each participant was kept confidential, with checklists coded and provided to individuals if needed. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki, and no coercion was imposed on participants. Subjects entered the study after receiving prepared written consent forms, and those who did not consent were assured that their information would not be disclosed.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript and consent to its publication. Informed consent was obtained from all participants involved in the study, who were made aware of the study\u0026apos;s purpose and their rights regarding participation and publication. The confidentiality of participants was maintained throughout the research, and no identifying information is included in the manuscript. The study was conducted in accordance with ethical standards, and consent for publication was obtained as per the guidelines of the Ethics Committee of Islamic Azad University, Najafabad Branch. This format ensures clarity and compliance with the journal\u0026apos;s requirements.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eCompeting interests\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe did not receive any funding or financial support for this study.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contributions \u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eDr. Behnam Haghpanah conceived of the presented idea. Ali Sohrabi, Omid Salimi, and Dr. Ehsan Taheri wrote the manuscript with consultation from all authors. Ali Sohrabi, Omid Salimi, and Shakiba Seifi conceived the study and were in charge of the overall direction and planning. With the help of Ali Khalifehsoltani and Kousha Heidarpour, data were collected through the Hospital information system and by interviewing patients. Alireza Amini filled out the forms. Ali Sohrabi and Dr. Behnam Haghpanah carried out the statistical analysis. All authors discussed the results and commented on the manuscript.\u003c/p\u003e\n\n\n\n\n\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe would like to express our gratitude to the staff of Shariati Hospital for their support and assistance in data collection and management. We also thank the participants of this study for their willingness to share their experiences and provide valuable information that contributed to this research. Additionally, we acknowledge the contributions of the Clinical Research Development Center at Najafabad Branch, Islamic Azad University, for their resources and support throughout this study. Finally, we appreciate the guidance and feedback from our colleagues and mentors, who were instrumental in refining our research and manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShukla R, Singh M, Jain R, Mahajan P, Kumar R. Functional outcome of bipolar prosthesis versus total hip replacement in the treatment of femoral neck fracture in elderly patients. Malaysian orthopaedic journal. 2017;11(1):1.\u003c/li\u003e\n\u003cli\u003eSolarino G, Moretti L, Vicenti G, Bizzoca D, Piazzolla A, Moretti B. Hip hemiarthroplasty with modular neck: is it useful in residents\u0026rsquo; learning curve? 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The Journal of Bone \u0026amp; Joint Surgery British Volume. 2010;92(3):406-12.\u003c/li\u003e\n\u003cli\u003eGao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: A meta-analysis. Clinical Orthopaedics and Related Research\u0026reg;. 2012;470:1782-91.\u003c/li\u003e\n\u003cli\u003eParker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane database of systematic reviews. 2010(6).\u003c/li\u003e\n\u003cli\u003eKeating J, Grant A, Masson M, Scott NW, Forbes J. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technology Assessment (Winchester, England). 2005;9(41):iii-iv, ix.\u003c/li\u003e\n\u003cli\u003eLangslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clinical Orthopaedics and Related Research\u0026reg;. 2014;472:1291-9.\u003c/li\u003e\n\u003cli\u003eInngul C, Hedbeck C-J, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial. International orthopaedics. 2013;37:2457-64.\u003c/li\u003e\n\u003cli\u003eHedbeck CJ, Blomfeldt R, Lapidus G, T\u0026ouml;rnkvist H, Ponzer S, Tidermark J. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. International orthopaedics. 2011;35:1703-11.\u003c/li\u003e\n\u003cli\u003eKannan A, Kancherla R, McMahon S, Hawdon G, Soral A, Malhotra R. Arthroplasty options in femoral-neck fracture: answers from the national registries. International orthopaedics. 2012;36:1-8.\u003c/li\u003e\n\u003cli\u003eLin C-C, Huang S-C, Ou Y-K, Liu Y-C, Tsai C-M, Chan H-H, et al. Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures. Asian journal of surgery. 2012;35(2):62-6.\u003c/li\u003e\n\u003cli\u003eSabnis BM, Brenkel IJ. Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures. Journal of Orthopaedic Surgery. 2011;19(1):8-12.\u003c/li\u003e\n\u003cli\u003eVan den Bekerom M, Hilverdink E, Sierevelt I, Reuling E, Schnater J, Bonke H, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. The Journal of Bone \u0026amp; Joint Surgery British Volume. 2010;92(10):1422-8.\u003c/li\u003e\n\u003cli\u003eBlomfeldt R, T\u0026ouml;rnkvist H, Eriksson K, S\u0026ouml;derqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. The Journal of Bone \u0026amp; Joint Surgery British Volume. 2007;89(2):160-5.\u003c/li\u003e\n\u003cli\u003ePark K-S, Oh C-S, Yoon T-R. Comparison of minimally invasive total hip arthroplasty versus conventional hemiarthroplasty for displaced femoral neck fractures in active elderly patients. Chonnam medical journal. 2013;49(2):81.\u003c/li\u003e\n\u003cli\u003eAhmad M, Xypnitos F, Giannoudis P. Measuring hip outcomes: common scales and checklists. Injury. 2011;42(3):259-64.\u003c/li\u003e\n\u003cli\u003eNilsdotter A, Bremander A. Measures of hip function and symptoms: Harris hip score (HHS), hip disability and osteoarthritis outcome score (HOOS), Oxford hip score (OHS), Lequesne index of severity for osteoarthritis of the hip (LISOH), and American Academy of orthopedic surgeons (AAOS) hip and knee questionnaire. Arthritis care \u0026amp; research. 2011;63(S11):S200-S7.\u003c/li\u003e\n\u003cli\u003eLewis DP, W\u0026aelig;ver D, Thorninger R, Donnelly WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. The Journal of arthroplasty. 2019;34(8):1837-43. e2.\u003c/li\u003e\n\u003cli\u003eEkhtiari S, Gormley J, Axelrod DE, Devji T, Bhandari M, Guyatt GH. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fracture: a systematic review and meta-analysis of randomized controlled trials. JBJS. 2020;102(18):1638-45.\u003c/li\u003e\n\u003cli\u003eSuarez JC, Arguelles W, Saxena A, Rivera P, Parris D, Veledar E. Hemiarthroplasty vs total hip arthroplasty for femoral neck fractures: 2010-2017 trends in complication rates. The Journal of arthroplasty. 2020;35(6):S262-S7.\u003c/li\u003e\n\u003cli\u003eLi X, Luo J. Hemiarthroplasty compared to total hip arthroplasty for the treatment of femoral neck fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2021;16:1-9.\u003c/li\u003e\n\u003cli\u003eSu Y, Li R, Ren X, Wang Y, Bai X, Zhang Y, et al. The health-related quality of life for hemiarthroplasty and total hip arthroplasty in the elderly: A meta-analysis. Frontiers in Medicine. 2023;10:1022584.\u003c/li\u003e\n\u003cli\u003eOkike K, Prentice HA, Chan PH, Fasig BH, Paxton EW, Bernstein J, et al. Unipolar hemiarthroplasty, bipolar hemiarthroplasty, or total hip arthroplasty for hip fracture in older individuals. JBJS. 2024;106(2):120-8.\u003c/li\u003e\n\u003cli\u003eTohidi M, Mann SM, McIsaac MA, Groome PA. Comparative effectiveness of total hip arthroplasty and hemiarthroplasty for femoral neck fracture: a propensity-score-matched cohort study. JBJS. 2023;105(8):591-9.\u003c/li\u003e\n\u003cli\u003eKonyves A, Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. The Journal of Bone \u0026amp; Joint Surgery British Volume. 2005;87-B(2):155-7.\u003c/li\u003e\n\u003cli\u003eKer\u0026scaron;ič M, Dolinar D, Antolič V, Mavčič B. The impact of leg length discrepancy on clinical outcome of total hip arthroplasty: comparison of four measurement methods. The Journal of arthroplasty. 2014;29(1):137-41.\u003c/li\u003e\n\u003cli\u003ePlaass C, Clauss M, Ochsner PE, Ilchmann T. Influence of leg length discrepancy on clinical results after total hip arthroplasty-a prospective clinical trial. Hip international. 2011;21(4):441-9.\u003c/li\u003e\n\u003cli\u003eFan L, Dang X, Wang K. 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PLoS One. 2012;7(6):e39531.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total hip arthroplasty, bipolar hip hemiarthroplasty, femoral neck fracture, elderly patients, surgical outcomes, patient satisfaction, quality of life, limb length discrepancy, postoperative complications, reoperation","lastPublishedDoi":"10.21203/rs.3.rs-4886633/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4886633/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFemoral neck fractures, particularly prevalent among the elderly, demand timely and appropriate treatment due to high costs and the potential for severe complications. Selecting the correct treatment method is essential to prevent long-term issues such as dislocation and the need for reoperation. This study compares the outcomes of total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA) in treating femoral neck fractures. This retrospective, applied, observational, and descriptive-analytical study was conducted on 48 patients (24 in the THA group and 24 in the BHA group). Patient information was obtained from the surgical archives of Shariati Hospital in 2020\u0026ndash;2021. During a telephone call, patients were asked questions from the Oxford Hip Scoring Questionnaire. Data were analyzed using the chi-square test, and significance was tested. Results are presented quantitatively.\u003c/p\u003e \u003cp\u003eResults showed that patients who underwent total hip arthroplasty scored an average of 7.5 points higher than those who had bipolar hemiarthroplasty, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests that total arthroplasty may offer better overall performance and outcomes in terms of pain reduction and joint efficiency for patients over 50 years old. The superiority of total arthroplasty was observed across all age groups, with the most pronounced difference in the 60\u0026ndash;69 age range (14.43 points), followed by the 50\u0026ndash;59 age group (2.15 points), and the smallest difference in patients 70 years and older (1.38 points). These findings indicate that total hip arthroplasty may be particularly beneficial for patients between 50 and 69 years old, while the advantage becomes less pronounced in patients 70 years and older. Individual patient factors, including comorbidities and activity levels, should guide the choice between THA and BHA. Further research with larger sample sizes and extended follow-up periods is necessary to confirm these results and inform optimal clinical decision-making for treating femoral neck fractures.\u003c/p\u003e","manuscriptTitle":"Title: Comparative Outcomes of Total Hip Arthroplasty and Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures: A Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-19 11:02:50","doi":"10.21203/rs.3.rs-4886633/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"de1c907c-5aa9-4e59-bd5a-3b7eb4bb3a4c","owner":[],"postedDate":"September 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T09:09:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-19 11:02:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4886633","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4886633","identity":"rs-4886633","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}