Risk factors for bipolar hemiarthroplasty dislocation: a retrospective cohort study

Bipolar hemiarthroplasty (BHA) is widely used for displaced femoral-neck fractures; however postoperative dislocation remains a serious complication. Reported risk factors vary considerably. This study investigated the clinical, surgical and radiographic parameters associated with dislocation following BHA.

We conducted a retrospective single‑center cohort study of 434 patients who underwent BHA for femoral‑neck fractures at a level‑I trauma center between 1 January 2016 and 31 December 2020. Demographics, comorbidities, surgical approach (timing and duration), and postoperative radiographs were analyzed. Patients with and without dislocation were compared using univariate analyses. Receiver operating characteristic (ROC) analysis and logistic regression were performed to assess predictive value. In a nested case-control subanalysis, each dislocation case was matched with five age and sex matched controls for detailed comparison analysis.

The cohort included 165 men and 269 women (mean age 81.9 years); dislocation occurred in 2.5% of patients (n = 11). Age, sex, dementia, Parkinson's disease, time to surgery and operative duration were not associated with dislocation. Operations performed outside daytime hours were more frequent among dislocated cases (45% vs. 20%, p = 0.016). Dislocated hips had a smaller center-edge angle (CEA), larger femoral neck-shaft angle (FNSA), reduced contralateral offset and higher bipolar head extrusion index. A CEA ≤ 25° predicted dislocation with high specificity but low sensitivity. Logistic regression suggested nighttime surgery as an additional potential predictor.

Pre‑operative evaluation of CEA and consideration of operative timing may help identify patients at increased risk of dislocation following BHA. Prospective randomized trials are required to confirm these associations, clarify causality, and develop preventive strategies.