European Journal of Cardiovascular Medicine

Fracture of the femur is the primary reason elderly individuals are admitted to the hospital. The frequency of such admissions is increasing because of longer life expectancy, osteoporosis, and sedentary lifestyles. A conservative treatment approach is not appropriate as it leads to non-union with unstable hip movements, restricted hip movements, and complications from prolonged immobilization such as bedsores, DVT, and respiratory infections. Various internal fastening options such as screws, dynamic hip screw plates, or blade plates can be used along with Hemi/total hip arthroplasty.

Hemiarthroplasty is a well-established surgical procedure utilized to address displaced femoral neck fractures in elderly individuals. Positive results have been achieved in terms of pain reduction, quick return to previous lifestyle, and lower rates of mortality and morbidity compared to osteosynthesis [1-3].Bipolar hemiarthroplasty is considered the most effective treatment for acute spinal fractures in elderly patients. There is a lack of evidence regarding its long-term effects. Some scholars have questioned the effectiveness of long-term use due to doubts about the extent of internal motion.[4]

Cemented prostheses are commonly utilized due to the decreased bone density in elderly patients, many of whom have a wide proximal medullar canal diameter. Bone cement facilitates immediate adhesion between bone and prosthesis, enabling optimal weight-bearing.[5] Cemented bipolar hemiarthroplasty offers more benefits than uncemented bipolar hemiarthroplasty, including increased stability in elderly patients with osteoporosis, facilitating early mobilization and reducing the risk of thigh pain.[6] 44 patients, predominantly female, with an average age of 72.72 years and a broken femur neck were treated with cemented bipolar hemiarthroplasty in our study.Complications during and after surgery have been documented

The current prospective study was conducted on 36 patient over 50 years old with intra-capsular fracture neck of femur treated by hemiarthroplasty using Bipolar endoprosthesis to assess the functional outcome and quality of life regarding pain, mobility, stability using Harris Hip Score, in the Department of Orthopedics at tertiary care center in Central India over a period of 1 year . The work has been carried out according to the Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans written informed consent was obtained from all participants. Patients with age ≥50 years, presenting with intra-capsular femoral neck fractures,both male and female Gender were included. Patients who refuse to participate in the study, Patients with acetabular or lower limb fracture and deformity of knee or ankle joint or Pathological fractures and those who lost to follow-up and patient with Active infection were excluded.
Surgical management using bipolar hemiarthroplasty, Hemiarthroplasty was indicated for patients with femoral neck fractures displacement, Antibiotic impregnated cement was used for some high-risk patients. Patients with dialysis, may be prone to sepsis, so antibiotics-impregnated cement should be given for them. The suitable antibiotics including vancomycin, tobramycin, cefazolin, and erythromycin.
Preoperative Planning: Preoperative planning is important, so, the preoperative X-ray was reviewed and templated for suitable size and for the fixation. Upon these findings, suitable implant selection should be done to proceed with a tapered stem and a full coated madullary locking stem, or include a cemented stem.
The patient should carry preoperative workup including medical, cardiac, and anesthesia evaluations, in addition to availability of Banking blood, preoperative laboratory investigations, and radiological evaluation.
All patients were treated by cemented bipolar hemiarthroplasty.
The patients were admitted where the following measures were undertaken:
Clinical evaluation: Demographic information of the patient provided. Personal information: name, age, gender, occupation; Cause of injury: Medical history includes diabetes mellitus (DM), hypertension, bronchial asthma, or stroke; Activity level before the fracture occurred;The patient is suitable for surgery. The physical examination involves a general assessment to evaluate overall fitness for surgery and to detect any possible sources of infection. Examine the skin and soft tissue around the hip joint, taking note of any scars or bedsores. Leg length inequality; Existence of malformation. Radiographic assessment involved obtaining anteroposterior radiographs of the pelvis and both hips for all patients, as well as a lateral X-ray of the afflicted hip.Lab investigation includes a Complete Blood Count (CBC) measuring Hemoglobin (Hb), Total Leukocyte Count (TLC), and platelets, as well as routine blood tests such as Blood Grouping, Typing, and Random Blood Sugar (RBS). Renal function is assessed by measuring serum urea and creatinine levels. Fasting blood sugar levels, Coagulation profile including Prothrombin time (PT), partial Thromboplastin time (PTT), and International Normalized Ratio (INR). Electrocardiography (ECG) with Chest X-ray Liver function tests including ALT, AST, bilirubin, and albumin, as well as HbsAg, HCV Ab, and HIV assays were conducted. Optimizing medical conditions such as diabetes and hypertension.Patients with medical conditions such anemia, hypertension, ischemic heart disease (IHD), diabetes, asthma, and COPD received appropriate medication prior to surgery.Patients were monitored after surgery at one month, three months, and six months. During each follow-up, patients were evaluated clinically and functionally for pain, limp, support, and range of motion. Radiological evaluations were conducted during follow-up appointments at 6 weeks, 3 months, and 6 months. At the final follow-up, findings were categorized as outstanding, good, fair, or bad based on the modified Harris Hip Score. All patients fully recovered after 6 months
Statistical analysis: The collected data was entered to and analyzed by computer using Statistical Package of Social Services, version 25 (SPSS). Results were presented by tables and graphs. Quantitative data was presented as mean and standard deviation. Qualitative data was presented as frequencies and proportions. Pearson Chi square test (χ2) and fisher’s exact were used to analyze qualitative independent data. P value of≤0.05 was taken as significant

Table 1 presents the age and sex distribution of the study group. Among the participants, 44.4% fell within the age range of 50-65, while 55.6% were aged over 65. The mean age of the study group was calculated to be 64.2 years with a standard deviation of 5.7 years. In terms of sex distribution, 44.4% of the participants were male, while 55.6% were female. These findings provide an overview of the demographic characteristics of the study population, delineating age and sex distributions for further analysis and interpretation.

Table 2 displays the evaluation of Harris Hip Scores within the study group. Out of 36 participants, 50.0% achieved an excellent score, while 38.9% attained a good score. A smaller proportion of participants, 5.5% each, fell into the fair and poor categories. The mean Harris Hip Score for the study group was calculated to be 88.9 with a standard deviation of 4.7. These findings offer an assessment of hip function and outcomes within the study population, reflecting a range of scores from excellent to poor, with the majority achieving favorable outcomes

Table 3 presents various parameters assessed within the research group, including injury side, pain levels, limping, support required, distance walked, range of motion, leg length discrepancy, post-operative complications, and stem position on radiographs.
Regarding the side of injury, an equal distribution is observed between left and right sides, with 50.0% each. In terms of pain, the majority of participants (66.7%) reported no pain, while 27.8% reported slight pain and 5.5% reported moderate pain. Limping was observed in varying degrees, with 50.0% reporting none, 38.9% reporting slight limping, and 11.1% reporting moderate limping.
Regarding support needed, half of the participants (50.0%) required no support, while 44.5% used a cane for long walks, and 5.5% used two canes. The majority of participants (66.7%) could walk unlimited distances, while 27.8% could walk up to 600 meters, and 5.5% were restricted to indoor walks only.
Range of motion varied, with 55.6% having a range of motion between 161-210 degrees and 44.4% between 211-300 degrees. Leg length discrepancy was present in 16.7% of participants, with the majority (83.3%) having no discrepancy.
Post-operative complications were observed in 11.1% of participants, primarily superficial infections. Radiological results indicated that 83.3% of stem positions were central, while 11.1% were in varus and 5.6% were in valgus. These findings provide a comprehensive overview of the outcomes and complications within the research group following hip surgery

Fracture of the femoral neck is frequently observed in elderly patients as a result of osteoporosis and is typically linked to a minor injury.[7] The restricted and vulnerable blood supply to the femoral head, fractures located within the joint capsule, and osteoporosis are the primary factors that impede healing, ultimately resulting in avascular necrosis of the femoral head.[8]
Surgery is the most effective treatment for femoral neck fractures. However, the initial method of internal fixation had a high failure rate, leading to complications such as nonunion and avascular necrosis. [9]The complications were resolved through hemiarthroplasty surgery for a fractured neck of the femur. Several studies have shown positive outcomes with internal fixation, and hemiarthroplasty is considered the most effective treatment for femoral neck fractures with displacement. Total hip arthroplasty is regarded as the optimal procedure for active individuals with a lengthy life expectancy and arthritic joints.[10]

There is significant controversy surrounding the treatment of neck of femur fractures in the elderly. An orthopaedic surgeon treating fractures in elderly patients can choose between unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty. Bipolar hemiarthroplasty is considered the most effective treatment for displaced fractures of the femoral neck in elderly patients.[11] Bipolar hemiarthroplasty is the preferred surgical treatment for displaced fractures of the femoral neck in elderly individuals. The surgeons choose hemiarthroplasty due to its quick functional recovery and lower reoperation rate compared to internal fixations.
Nevertheless, the outcomes of hemiarthroplasties vary, likely influenced by the diversity of prostheses utilized, the selected surgical approach, and the postoperative rehabilitation methods implemented [12]. The study group had an average age of 64.2±5.7 years, ranging from 53 to 77 years. 55.6% of the participants were over 65 years old, consistent with Jindal et al.'s findings that most patients were aged between 56 and 70 years. Mue et al. reported a similar age distribution with a mean age of 65 years in their study groups.[13] 55.6% of the study group were females and 44.4% were males. Rezaie et al. reported a sex distribution of 60.9% females and 39.1% males.[14]

Bipolar hemiarthroplasty with cement fixation is a favorable treatment choice for elderly patients with a fractured neck of femur. Mobilization and initial functional outcomes range from good to satisfactory. The procedure has a very low complication rate and restores pre-injury functional status in most patients

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