Surgical management of intracapsular fracture neck femur by hemiarthroplasty between uncemented bipolar prosthesis and Austin Moore’s prosthesis: a comparative study in elderly population

H. D. Veeranna, K. B. Ravi, K. Anudeep Kumar


Background: Intracapsular femoral neck fractures are common in elderly population after a simple fall. To avoid the drawbacks of internal fixation and for the early mobilization, hemiarthroplasty is performed in elderly. The aim of this study is to compare the outcome AMP with uncemented bipolar prosthesis in geriatric patients.

Methods: 51 patients above 60 years and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either AMP (Austin Moore prosthesis) or bipolar hemiarthroplasty, in the Department of Orthopaedics, Sri Siddhartha medical college, Tumkur between April 2014 and May 2017. The patients were summoned at 6 weeks, 12 weeks, 6 months and 1 year. Functional outcome was assessed and compared with modified Harris hip score and radiological parameters.

Results: The mean Harris hip score in bipolar and AMP group was 86.31±12.1 and 79.86±15.42, respectively (p=0.182). The range of motion was 204.52±28.2 and 183.62±36 (p=0.014) respectively. Functional activities like use of public transport and ability to wear shoe or socks was better with bipolar group. Incidence of complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion was encountered in AMP group.

Conclusions: The use of uncemented bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.



Unipolar, Bipolar, AMP, Hemiarthroplasty, Femur neck fracture

Full Text:



Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H. Epidemiology of femoral neck fractures. Injury. 2002;33(3):1-7.

Lu-Yao GL, Keller RB, Littenberg B, Weinberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76:15-25.

Van Vugt AB. The unsolved fracture. A prospective study of 224 consecutive cases with an intracapsular hip fracture. University of Nijmegen, Netherlands. Ref Type: Thesis/Dissertation, 1991.

Nicoll EA. The unsolved fracture. J Bone Joint Surg Br. 1963;45:239-41.

Rockwood CA, Jr, Green DP, Bucholz RW, Heckman JD. Fractures in adults. Philadelphia: Lippincott; 1996.

Moore AT, Bohlman HR. Metal Hip Joint: A Case Report. J Bone Joint Surg. 1943;25:688-92.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737–55.

Rosner B. Fundamentals of Biostatistics. 5th Edition. Duxbury; 2000: 80-240.

Riffenburg RH. Statistics in Medicine, second edition, Academic Press; 2005: 85-125.

Sunder Rao PS, Richard J. An Introduction to Biostatistics, A manual for students in health sciences, 4th edition. New Delhi: Prentice Hall of India; 2006: 86-160.

Suresh KP, Chandrasekhar S. Sample Size estimation and Power analysis for Clinical research studies. J Human Reprod Sci. 2012;5(1):7-13.

Ninh CC, Sethi A. Hip dislocation after modular unipolar Hemiarthroplasty. J Arthroplasty. 2009;24(5):768-75.

Butler M, Norton R, Lee-Joe T, Cheng A, Campbell AJ. The risk of hip fracture in older people from private homes and institutions. Age Ageing. 1996;25:381-5.

Hinton RY, Smith GS. The association of age, race and sex with the location of proximal femoral fractures in the elderly. J Bone Joint Surg. 1993;75:752-9.

Arvade DJ. A review of internal fixation and prosthetic replacement for fresh fractures of the femoral neck. Clini Orthop India. 1987;1:77-82.

Kulkarni GS. Pathology of fracture neck of the femur. Clin Orthop India. 1987;1:92-6.

Su H, Aharonoff GB, Hiebert R, Zuckerman JD, Koval KJ, et al. In hospital mortality after femoral neck fracture: do internal fixation and hemiarthroplasty differ? Am J Orthop. 2003;32:151-5.

Cadler SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ. Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomized prospective study J Bone Joint Surg Br. 1996;78:391-4.

Sabnis BM, Brenkel IJ. Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures. J Orthop Surg. 2011;19(1):8-12

Davison JN, Cadler SJ, Anderson GH, Ward G, Jagger C, Harper WM, et al. Treatment for displaced intracapsular fracture of the proximal femur. A prospective randomized trial in patients aged 65 to 79 years. J Bone Joint Surg Br. 2001;83:206-12.

Ong BC, Maurer SG, Aharonaff GB, Zuckerman JD, Koval KJ. Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up. J Orthop Trauma. 2002;16(5):317-22.

Raia FJ, Chapman CB, Herrera MF, Schweppe MW, Michelsen CB, Rosenwasser MP. Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 2003;414:259-65.

Wacht SW, Jakob RP, Gautier E. Ten year patient and prosthesis survival after unipolar hip hemiarthroplasty in female patients over 70 years. J Arthroplasty. 2003;18(5):587-91.

Norrish AR, Rao J, Parker MJ. Prosthesis survivorship and clinical outcome of the Austin Moore hemiarthroplasty: an 8 year mean follow-up of a consecutive study of 500 patients. Injury. 2006;37(8):734-9.

Naser MA, Pathak R, Ahmad A. Superiority of fixed stem bipolar prosthesis over Austin Moore prosthetic in fracture neck femur. Int J Res Orthop. 2018;4:577-81.