Clinical and functional outcomes of primary bipolar hip arthroplasty: A prospective observational study

Primary bipolar hip arthroplasty is commonly used to manage displaced femoral neck fractures in elderly patients, offering early mobilization and reduced surgical burden compared with total hip arthroplasty. However, long-term functional outcomes and predictors of recovery remain variable. This study aimed to prospectively evaluate the clinical and functional outcomes of primary bipolar hip arthroplasty.

This prospective observational study included 196 patients who underwent primary bipolar hip arthroplasty between January 2016 and September 2024 in three university-affiliated teaching hospitals. Functional outcomes were assessed using the Harris Hip Score (HHS), while postoperative complications were recorded for one year. Patients were stratified by age (<60 vs. ≥60 years) to examine the impact of demographic factors on outcomes. Statistical analysis included correlation and subgroup comparisons with significance set at p < 0.05.

The mean age of participants was 68.7 ± 11.9 years, and the mean follow-up was 46.97 ± 25.21 months. No major complications or revision surgeries occurred; 4.0% of patients developed superficial wound infections. Overall, the mean HHS was 50.51 ± 18.59, with 79.6% of patients achieving poor scores. Younger patients (<60 years) demonstrated better functional outcomes, particularly in mobility-related domains (p = 0.06), while most older patients (≥60 years) had poor long-term functional results. A significant negative correlation was observed between age and HHS (r = -0.379, p = 0.007).

Bipolar hemiarthroplasty is a safe procedure with low complication and revision rates. However, long-term functional outcomes are modest, especially in elderly patients, likely influenced by age, comorbidities, preoperative status, and acetabular erosion. Individualized patient selection and long-term monitoring of hip function are recommended to optimize recovery.