Comparing Austin Moore and Bipolar Prostheses for Management of Femoral Neck Fractures in Low-Resource Hospitals in Rural India.

BACKGROUND

Femoral neck fractures in elderly individuals cause significant morbidity, and their management is particularly challenging in rural areas where healthcare access is limited. The recommended treatment for displaced femoral neck fractures in elderly patients with poor mobility, cognitive dysfunction and multiple comorbidities is a hemiarthroplasty, which can be performed with various implants, including monopolar implants like Austin Moore prosthesis (AMP) and bipolar prosthesis (BP). In developing countries like India, rural areas often have constraints with healthcare resources. Furthermore, the per-capita income is low, limiting access to affordable healthcare. As a result, treatment is often tailored to ensure affordability, and AMP continues to be used as it is a relatively inexpensive implant. The objective of our study is to assess and compare the mortality, infection rate and functional outcomes (Harris hip score [HHS]) of AMP and BP in treating femoral neck fractures one year following surgery in a resource-constrained setting in a rural district general hospital in India.

METHODOLOGY

This retrospective observational study analysed all patients who underwent a hemiarthroplasty for acutely displaced femoral neck fractures between 1 January 2017 and 31 December 2017, with a minimum one-year follow-up following surgery. Pathological hip fractures, patients with pre-existing hip pathologies and those with an abbreviated mental test score of six or less were excluded. Medical records were reviewed, and demographic data, mortality, infection rates and HHS one year following surgery were recorded and compared for patients who underwent hemiarthroplasty with an AMP and BP.

RESULTS

A total of 118 patients underwent hemiarthroplasty, with two (1.69%) lost to follow-up. Therefore, 116 patients were included, comprising 81 (69.83%) women and 35 (30.17%) men, with similar demographics between both groups. No statistically significant difference was found in mortality rate (AMP 1, 1.79%, vs. BP 1, 1.67%, = 0.96), infection rate (AMP 1, 1.82%, vs. BP 1, 1.69%, = 0.96) and HHS (AMP 85.2 vs. BP 88.5; = 0.08). No dislocations or periprosthetic fractures were noted at one-year follow-up in both groups.

CONCLUSIONS

While AMP and BP have similar clinical and functional outcomes, AMP is more cost-effective and perhaps more suitable in low socioeconomic demographics and low-resource settings. Further research is suggested to evaluate long-term outcomes in underserved populations with a low per-capita income.