Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 7

Hip Hemiarthroplasty in the Treatment of Femoral Neck Fracture: A Retrospective Analysis of 267 Patients

Guilherme Correia*, Mário Baptista, Paulo Cunha, Pedro Pinho, Pedro Varanda and Bruno Direito-Santos

Department of Orthopaedics and Traumatology, Hospital de Braga, R. das Comunidades Lusíadas, Portugal

*Corresponding Author: Guilherme Correia, Department of Orthopaedics and Traumatology, Hospital de Braga, R. das Comunidades Lusíadas, Portugal.

Received: May 03, 2023; Published: June 19, 2023


Purpose: Hip hemiarthroplasty (HA) is considered the best surgical choice in the treatment of femoral neck fracture (FNF) in elderly and low demanding patients, allowing immediate full weight bearing and decreased reoperation rate. HA instability is a serious complication that can lead to revision surgery and dictate lower survival rates. The aim of this study was to identify clinical risk factors associated with an increased risk of dislocation after cemented HA through posterolateral approach.

Methods: Retrospective study of patients with FNF admitted to our institution between 2014 and 2019, treated with bipolar/unipolar cemented HA using a posterolateral approach. Data collected from hospital database included patient demographics, mortality, complications and requirement for revision.

Results: Overall, 267 patients were submitted to HA (84.6% bipolar), with an average age of 84.5±7.1 years and 72% were female. The median hospital stay was 13 days and 43.1% presented medical complications. The prosthesis related complications rate was 13.8% (11.6% instability, 1.1% periprosthetic fracture and 1.1% implant infection) and revision was required in 8.6%. Previous inability to walk [OR 8.55 (95% CI: 3.27-22.38, p<0.001)] and male gender [OR 2.51 (95% CI: 1.11-5.65, p=0.026)] where identified as risk factors for instability. One-year mortality rate was 26.7% and was higher among males (p=0.012).

Conclusion: The instability incidence of cemented HA using posterolateral approach in this study was 11.6%. Previous inability to walk and male gender were identified as risk factors for dislocation after posterolateral approach and may indicate other surgical approaches or treatments.

Keywords:Femoral Neck Fractures; Hip Hemiarthroplasty Dislocation; Complications; Dislocation; Bipolar Hemiarthroplasty; Unipolar Hemiarthroplasty


  1. Lewis DP., et al. “Hemiarthroplasty vs Total Hip Arthroplasty for the Management of Displaced Neck of Femur Fractures: A Systematic Review and Meta-Analysis”. The Journal of Arthroplasty 8 (2019): 1837-1843.e1832.
  2. Sonaje JC., et al. “Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study”. European Journal of Orthopaedic Surgery and Traumatology : Orthopedie Traumatologie 3 (2018): 493-498.
  3. Peng W., et al. “Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis”. Chinese Journal of Traumatology 6 (2020): 356-362.
  4. Zhang Y., et al. “Morphological risk factors associated with dislocation after bipolar hemiarthroplasty of the hip in patients with femoral neck fractures-a nested case-control study”. Journal of Orthopaedic Surgery and Research 1 (2017): 395-395.
  5. Jones C., et al. “The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management”. The Open Orthopaedics Journal 11 (2017): 1200-1212.
  6. Van der Sijp MPL., et al. “Surgical Approaches and Hemiarthroplasty Outcomes for Femoral Neck Fractures: A Meta-Analysis”. The Journal of Arthroplasty 5 (2018): 1617-1627.e1619.
  7. Hughes AW., et al. “Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach: a cadaver study”. The Bone and Joint Journal 97-b.1 (2015): 141-144.
  8. Ninh CC., et al. “Hip dislocation after modular unipolar hemiarthroplasty”. The Journal of Arthroplasty 5 (2009): 768-774.
  9. Salem KM., et al. “Predictors and outcomes of treatment in hip hemiarthroplasty dislocation”. Annals of the Royal College of Surgeons of England 6 (2014): 446-451.
  10. Enocson A., et al. “Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips”. Acta Orthopaedica 2 (2008): 211-217.
  11. Abram SG and Murray JB. “Outcomes of 807 Thompson hip hemiarthroplasty procedures and the effect of surgical approach on dislocation rates”. Injury 6 (2015): 1013-1017.
  12. Rogmark C., et al. “Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients”. Acta Orthopaedica 1 (2014): 18-25.
  13. Wang B., et al. “Risk Factors with Multilevel Evidence for Dislocation in Patients with Femoral Neck Fractures After Hip Hemiarthroplasty: A Systematic Review”. Indian Journal of Orthopaedics 6 (2020): 795-804.
  14. Kristensen TB., et al. “Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture”. Acta Orthopaedica 1 (2017): 29-34.
  15. Madanat R., et al. “Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case-control study”. International Orthopaedics 5 (2015): 935-940.
  16. Gill JR., et al. “Management and outcome of the dislocated hip hemiarthroplasty”. The Bone and Joint Journal 100-b.12 (2018): 1618-1625.
  17. Hedbeck CJ., et al. “Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial”. International Orthopaedics 11 (2011): 1703-1711.
  18. Sullivan NP., et al. “Early complications following cemented modular hip hemiarthroplasty”. The Open Orthopaedics Journal 9 (2015): 15-19.
  19. Veronese N and Maggi S. “Epidemiology and social costs of hip fracture”. Injury 8 (2015): 1458-1460.
  20. Van den Bekerom MP., et al. “The natural history of the hemiarthroplasty for displaced intracapsular femoral neck fractures”. Acta Orthopaedica 6 (2013): 555-560.
  21. Sabnis B and Brenkel IJ. “Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures”. Journal of Orthopaedic Surgery (Hong Kong) 1 (2011): 8-12.
  22. Rubin LE., et al. “Hip Resection Arthroplasty”. JBJS Reviews 5 (2015).
  23. Rajeev A and Banaszkiewicz P. “Constrained captive acetabular cup for recurrent dislocation of hemiarthroplasty in elderly: A case series”. International Journal of Surgery Case Reports 23 (2016): 141-145.
  24. Mazen S., et al. “Retrospective evaluation of bipolar hip arthroplasty in fractures of the proximal femur”. North American Journal of Medical Sciences 9 (2010): 409-415.
  25. Hongisto MT., et al. “Lateral and Posterior Approaches in Hemiarthroplasty”. Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society 3 (2018): 260-268.
  26. Biber R., et al. “Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases”. International Orthopaedics 11 (2012): 2219-2223.
  27. Leonardsson O., et al. “The surgical approach for hemiarthroplasty does not influence patient-reported outcome : a national survey of 2118 patients with one-year follow-up”. The Bone and Joint Journal 98-b.4 (2016): 542-547.
  28. Mukka S., et al. “Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures”. Orthopaedics and Traumatology, Surgery and Research : OTSR8 (2016): 1049-1054.
  29. Ozan F., et al. “Effects of Hardinge versus Moore approach on postoperative outcomes in elderly patients with hip fracture 9 (2016): 4425-4431.
  30. Svenøy S., et al. “Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: Early complications in a prospective cohort of 583 patients”. Injury 7 (2017): 1565-1569.


Citation: Guilherme Correia., et al. “Hip Hemiarthroplasty in the Treatment of Femoral Neck Fracture: A Retrospective Analysis of 267 Patients”.Acta Scientific Orthopaedics 6.7 (2023): 38-44.


Copyright: © 2023 Guilherme Correia., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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