Management of Fracture Neck Femur in Elderly Patients Using Dual Mobility Cup Arthroplasty versus Bipolar Hemiarthroplasty

Abstract

Abstract Purpose Femoral neck fractures represent a major public health problem worldwide. The purpose of this study is to evaluate the clinical, functional outcome and rate of complications of dual mobility cup total hip arthroplasty versus bipolar hemiarthroplasty in the management of displaced fracture neck femur in elderly patients. Methods A prospective Randomized control study was done in a university specialized unit between January 2018 till January 2021 on forty elderly patients had a mean age of 70.5 years (range 60-91) with displaced Fracture neck of femur. Twenty patients were managed by Dual Mobility Cup Total Hip Arthroplasty (DM group) and 20 patients underwent Bipolar Hemiarthroplasty (BHA group) for the treatment of their femoral neck fractures with a minimum 24 months folow up (range 24- 35). Functional outcome (Haris Hip Score) and rate of dislocation postoperatively were the primary outcomes while intraoperative blood loss, blood transfusion rate, length of operation, postoperative infection and mortality rate were the secondary outcomes. Results The Harris hip score (HHS) was higher in the DM group and was most significant after 6 and 12 months with p-value (p < 0.05). The dislocation rate was less in the DM group. The BHA group demonstrated less intra-operative blood loss (p < 0.001). and a shorter length of operation (p < 0.001). However, there was no significant difference in two-year mortality with p-value (P > 0.05), blood transfusion rate with p-value (p = 0.471) and infection rate with p-value (p = 1.000). Conclusion The use of THA DMC did not seem to increase mortality, morbidity, or complications rate like infection or bleeding but it decreases dislocation rate and increase functional outcome (especially in active healthy patients) when compared to BHA. Also, THA DMC is not affected by pelvic morphological factors and dysplasia which may lead to dislocation with BHA.