Outcomes of Total Hip Arthroplasty and Contralateral Bipolar Hemiarthroplasty: A Case Series

There is continuing controversy about whether total hip arthroplasty or bipolar hemiarthroplasty should be used for the management of displaced subcapital hip fractures or advanced avascular necrosis of the femoral head, especially in patients with normal-appearing acetabular cartilage. The decision regarding which procedure to perform may be influenced by several factors, including the underlying disease process, perioperative risks 1,2, likelihood of revision 3-5, and economic considerations 6-8. Published reports are difficult to interpret because the series differ with regard to the surgeons performing the operations, surgical approaches, methods of fixation, postoperative protocols, patient mix, and duration of follow-up 3,5,9-18. In our retrospective review, we compared the clinical and radiographic results and patient-reported outcomes of the two procedures in nine patients who had undergone a bipolar hemiarthroplasty on one side and a total hip arthroplasty on the other. We conducted a retrospective review of the records on 750 consecutive hip arthroplasties performed between 1988 and 1995, and we identified seventy-five patients (10%) who had undergone bilateral hip replacement. Of these, nine had undergone total hip arthroplasty on one side and bipolar hemiarthroplasty on the other. There were eight women and one man. The mean age (and standard deviation) at the time of the bipolar hemiarthroplasty was 74 ± 19 years (range, twenty-eight to eighty-seven years), and the mean age at the time of the total hip arthroplasty was 74 ± 18 years (range, twenty-seven to eighty-seven years). Eight bipolar hemiarthroplasties were performed because of a displaced subcapital hip fracture and one, because of avascular necrosis. Five total hip arthroplasties were performed because of a subcapital hip fracture; two, because of avascular necrosis; and two, because of osteoarthritis. All patients underwent staged bilateral hip replacement. A …