Hip fractures constitute one of the most serious musculoskeletal injuries affecting the elderly population and are associated with substantial morbidity, loss of independence, disability, mortality, and healthcare expenditure. With progressive population ageing and increasing prevalence of osteoporosis, the global burden of hip fractures continues to be considerable. Global Burden of Disease data demonstrate that hip fracture remains an important health problem among older adults across diverse geographical regions. ¹ Fractures of the femoral neck constitute a clinically important proportion of hip fractures in elderly individuals. Increasing age is accompanied by progressive reduction in bone mass, deterioration of bone microarchitecture, impaired neuromuscular coordination, reduced protective reflexes, visual impairment, and an increased tendency to fall. Consequently, relatively trivial trauma such as a fall from standing height may result in a femoral neck fracture. Women are particularly vulnerable because of the higher prevalence of postmenopausal osteoporosis, although the burden among elderly men is also substantial. ²

The global distribution of hip fractures shows marked geographical variation. Historically, higher incidence rates have been reported in North America and Northern Europe, but demographic transition is progressively shifting a substantial proportion of the burden towards Asia. The rapid increase in the elderly population in Asian countries means that the absolute number of fragility fractures is expected to increase substantially. India, with its large and ageing population, is therefore likely to experience an increasing clinical and socioeconomic burden from osteoporotic hip fractures. ² The Indian context is particularly important because elderly patients frequently present with coexisting medical illnesses, variable nutritional status, osteoporosis, delayed presentation, and differences in access to rehabilitation facilities. Indian epidemiological data on hip fracture are comparatively limited, but available literature has emphasized that developing countries such as India are expected to face an increasing burden as life expectancy rises.² Management strategies should therefore aim not merely at fracture treatment but also at early mobilization, restoration of independence, reduction of complications related to prolonged recumbency, and improvement in postoperative quality of life.

Intracapsular fractures of the femoral neck present unique therapeutic challenges because disruption of the vascular supply to the femoral head can predispose to avascular necrosis and non-union. In elderly patients with displaced fractures, these biological limitations, together with poor bone quality, can reduce the reliability of internal fixation. Arthroplasty consequently occupies an important role in the management of displaced intracapsular femoral neck fractures in older individuals. Current evidence supports both hemiarthroplasty and total hip arthroplasty as established surgical options, with selection influenced by age, pre-fracture activity, comorbidities, cognitive status, life expectancy, and functional requirements. ³ Hemiarthroplasty replaces the femoral head and neck while preserving the native acetabulum. Compared with total hip arthroplasty, it generally involves a less extensive surgical procedure and may offer advantages such as shorter operative duration, reduced blood loss, and a lower risk of dislocation in selected elderly patients. Meta-analytic evidence has nevertheless demonstrated that total hip arthroplasty may provide superior functional outcomes in highly active and medically fit elderly patients, highlighting the importance of appropriate patient selection. ³

Bipolar hemiarthroplasty was developed with an additional articulation between the prosthetic femoral head and its outer shell. This dual-articulation concept was intended to distribute movement between the inner bearing and the native acetabulum, theoretically reducing acetabular wear while maintaining satisfactory hip mobility. Bipolar hemiarthroplasty has consequently become an established treatment option for displaced femoral neck fractures in elderly patients, particularly where the primary therapeutic objectives are pain relief, early mobilization and restoration of functional. Evidence from Indian clinical practice has also demonstrated satisfactory outcomes following bipolar hemiarthroplasty. Marya et al. evaluated cementless bipolar hemiarthroplasty among elderly patients with femoral neck fractures and reported satisfactory postoperative mobility with a mean Harris Hip Score of 85 among patients available at final follow-up. Their findings supported the ability of bipolar hemiarthroplasty to facilitate return towards premorbid activity in appropriately selected elderly patients. ⁵

Functional recovery is particularly important in geriatric hip-fracture management because radiographic or surgical success alone does not necessarily represent successful treatment. The ability to walk independently, perform activities of daily living, negotiate stairs, use walking aids when necessary, and return towards the pre-fracture level of activity are clinically meaningful outcomes. Studies comparing hemiarthroplasty with total hip arthroplasty have therefore increasingly incorporated standardized functional assessment instruments in addition to mortality, complications and revision rates. ⁶ Among these instruments, the Harris Hip Score (HHS) remains one of the most widely used clinical tools for evaluating hip function. Originally introduced by Harris, the scoring system incorporates important domains including pain, function, absence of deformity and range of motion, thereby providing a structured quantitative assessment of postoperative hip performance. ⁷ The Modified Harris Hip Score retains the clinically important components of the original system and is particularly useful for longitudinal assessment of functional recovery after hip surgery. It prospectively evaluated 40 elderly patients above 60 years of age with intracapsular fracture neck of femur treated by bipolar hemiarthroplasty and followed them for six months, with functional outcome assessed using the Modified Harris Hip Score.

These observations emphasize that successful management of femoral neck fractures in elderly patients should be evaluated in terms of restoration of function rather than operative success alone. Assessment of functional outcome after bipolar hemiarthroplasty using a standardized scoring system can provide clinically meaningful information regarding pain relief, mobility, independence and overall recovery. Such evidence is especially relevant in the Indian setting, where locally generated prospective data on functional recovery following geriatric hip-fracture surgery remain valuable for treatment planning and rehabilitation.

AIM

To evaluate the functional outcome of bipolar hemiarthroplasty in elderly patients with intracapsular fracture neck of femur using the Modified Harris Hip Score.

OBJECTIVES

Primary Objective

1. To assess the short-term functional outcome following bipolar hemiarthroplasty for intracapsular fracture neck of femur in elderly patients using the Modified Harris Hip Score at 6 months.
2. Secondary Objectives
3. To assess postoperative functional parameters including pain, limping, requirement for walking support, walking distance, activities of daily living, deformity, leg-length discrepancy and range of movements following bipolar hemiarthroplasty.
4. To determine the proportion of patients achieving excellent, good, fair/satisfactory and poor functional outcomes following bipolar hemiarthroplasty.

Study Design The study was conducted as a prospective observational study. Study Setting The study was conducted in the Department of Orthopaedics, Mahadevappa Rampure Medical College, Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka. Study Population The study population consisted of elderly patients with intracapsular fracture neck of femur who underwent bipolar hemiarthroplasty. Sample Size A total of 40 patients were included in the study. The original study included 40 patients aged above 60 years, irrespective of sex, who underwent hemiarthroplasty using a bipolar endoprosthesis. All 40 patients were followed for six months and were included in the functional outcome analysis. Final sample size: n = 40 Sampling Method Eligible patients presenting during the study period who fulfilled the study criteria and underwent bipolar hemiarthroplasty were included in the study. Inclusion Criteria 1. Were older than 60 years. 2. Had an intracapsular fracture of the neck of femur. 3. Underwent bipolar hemiarthroplasty. 4. Were ambulatory before sustaining the fracture. 5. Were available for postoperative assessment and follow-up. Exclusion Criteria 1. Patients who had been non-ambulatory prior to the fracture. 2. Patients with dementia. 3. Patients with fracture neck of femur associated with other fractures. 4. Patients with pathological fractures. Data Collection After admission, relevant demographic and clinical information was recorded using the study proforma. A detailed history was obtained, including the mode of injury and associated medical illnesses. A thorough clinical assessment was performed in each patient. Patients were regularly observed throughout their hospital stay, and subsequent follow-up findings were documented in the follow-up section of the study proforma. Surgical Intervention All included patients underwent hemiarthroplasty using a bipolar prosthesis for intracapsular fracture neck of femur. Appropriate preoperative assessment and preparation were performed before surgery. Postoperative Management Postoperatively, vital parameters were monitored and appropriate analgesics and intravenous antibiotics were administered. Patients were mobilized early according to their clinical condition and pain tolerance. They were made to sit on the first postoperative day, stand with walker support on the second postoperative day, and were allowed full weight-bearing with a walker from the second postoperative day depending upon pain tolerance. Follow-up All patients were followed for a period of 6 months following bipolar hemiarthroplasty. Follow-up assessments were performed in the outpatient department and findings were documented in the follow-up proforma. Functional Outcome Assessment The primary functional outcome was assessed using the Modified Harris Hip Score (MHHS) at the end of the 6-month follow-up period. The assessment included clinically relevant parameters such as pain, limping, use of support, walking distance, ability to perform activities of daily living, deformity and range of hip movements. The final functional outcome was categorized according to the Modified Harris Hip Score into: • Excellent: 91–100 • Good: 81–90 • Fair/Satisfactory: 71–80 • Poor: <70 Outcome Measures Primary outcome: Functional outcome at 6 months as assessed using the Modified Harris Hip Score. Secondary outcomes: Pain, limping, requirement for support, walking distance, activities of daily living, deformity, leg-length discrepancy and range of hip movements. Ethical Considerations Ethical clearance was obtained from the institutional ethical committee before commencement of the study. Statistical Analysis The collected data were entered into a database and analysed using appropriate descriptive statistical methods. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized using appropriate measures of central tendency and dispersion. Functional outcomes were categorized according to the Modified Harris Hip Score.

The odds ratios ranged from 3.3 for myalgia to 4.7 for stiffness, indicating a strong association between LP and musculoskeletal involvement.

A total of 40 elderly patients with intracapsular fracture neck of femur who underwent bipolar hemiarthroplasty were evaluated. The mean age reported in the detailed results was 69.05 ± 8.0 years, and 21 (52.5%) patients were male.

Table 1. Age and Sex Distribution of Study Participants (n=40)

Mean age ± SD: 69.05 ± 8.0 years.

Interpretation: More than half of the patients (55.0%) were aged 60–69 years, while 15.0% were aged ≥80 years. There was a slight male predominance (52.5%). The study therefore represented predominantly patients in the younger segment of the elderly population.

Table 2. Functional Mobility Following Bipolar Hemiarthroplasty at 6 Months (n=40)

Interpretation: At 6 months, 52.5% had no limp and 50.0% required no walking aid. Among patients with residual limping, most had only a slight limp. These findings indicate generally satisfactory restoration of ambulatory function following bipolar hemiarthroplasty.

Table 3. Range of Hip Movement at 6-Month Follow-up (n=40)

Interpretation: The majority of patients (75.0%) were in the 211–300 range, while only 5.0% were in the lowest category.

Table 4. Modified Harris Hip Score Functional Outcome at 6 Months (n=40)

Observed score range: 48–96.

Interpretation: Excellent outcome was observed in 52.5%, good outcome in 15.0%, fair/satisfactory outcome in 22.5%, and poor outcome in only 10.0%. Overall, 27/40 (67.5%) achieved good-to-excellent functional outcomes at six months.

Table 5. Overall Functional Outcome Following Bipolar Hemiarthroplasty at 6 Months

p ≈ 0.038

Interpretation: Approximately two-thirds (67.5%) of the study participants achieved a good-to-excellent functional outcome following bipolar hemiarthroplasty, compared with 32.5% having fair-to-poor outcomes.

Overall Results Interpretation

At six months following bipolar hemiarthroplasty, the study demonstrated generally favourable functional recovery. Half of the patients required no walking support, 52.5% had no limp, and 75% demonstrated a good range of hip movement. Most importantly, 67.5% achieved good-to-excellent Modified Harris Hip Score outcomes, while only 10% were classified as having a poor outcome. These findings support satisfactory short-term functional recovery after bipolar hemiarthroplasty in this cohort.

The present prospective observational study evaluated the 6-month functional outcome of bipolar hemiarthroplasty in 40 elderly patients with intracapsular fracture neck of femur using the Modified Harris Hip Score. The mean age was 69.05 ± 8.0 years, with 55% of patients aged 60–69 years, and there was a slight male predominance (52.5%). Similar elderly populations have been evaluated in previous hemiarthroplasty studies, although several Western series included substantially older patients. Raia et al. studied 115 patients with a mean age of 82.1 years and found comparable functional and ambulatory outcomes between unipolar and bipolar hemiarthroplasty at one year.⁸ Functional recovery was satisfactory in the present study, with 52.5% excellent, 15% good, 22.5% fair/satisfactory and 10% poor outcomes, resulting in 67.5% good-to-excellent results at six months. Stoffel et al., in a randomized trial of 261 elderly patients with a mean age of 82.0 ± 7.9 years, compared cemented bipolar and unipolar hemiarthroplasty and assessed outcomes using Harris Hip Score, Oxford Hip Score and walking performance at 12 months. Their study demonstrated that bipolar hemiarthroplasty remained an acceptable option for restoring functional ability after intracapsular femoral neck fracture.⁹ The favourable Modified Harris Hip Score distribution observed in the present study is also supported by Malhotra et al., who compared bipolar hemiarthroplasty with Austin-Moore hemiarthroplasty in elderly Indian patients and demonstrated satisfactory clinical performance with the bipolar prosthesis.¹⁰ In another comparative study, bipolar hemiarthroplasty produced a mean Harris Hip Score of 86.18 ± 12.18, compared with 79.79 ± 15.55 following unipolar hemiarthroplasty, although the difference did not reach statistical significance. Importantly, range of movement was significantly better with bipolar hemiarthroplasty (210.63 ± 28.39 vs 181.58 ± 37.0; p=0.015).¹¹ In the present study, 75% of patients had a total range-of-movement value of 211–300, indicating good postoperative hip mobility. This is clinically important in the Indian setting because activities such as sitting cross-legged and squatting demand greater hip mobility than many routine Western activities. The better range of motion described in bipolar arthroplasty compared with unipolar implants in previous studies supports the satisfactory mobility observed in our cohort.¹¹ At six months, 52.5% of patients had no limp, while 37.5% had only a slight limp and 10% had a moderate limp. In addition, 50% required no walking support, 32.5% used a cane only for long walks and 17.5% used a cane most of the time. Bűcs et al. reported that patients undergoing bipolar hemiarthroplasty through a direct anterior approach had better early recovery, with limping at 12 weeks in only 5.9% compared with 46% following an anterolateral approach. They also reported significantly better Harris Hip Scores at 2 and 6 weeks (77 vs 65 and 91 vs 77, respectively; p<0.05).¹² These findings highlight the contribution of surgical approach, abductor preservation and rehabilitation to postoperative gait. The proportion of good-to-excellent results in the present study is also consistent with studies comparing bipolar hemiarthroplasty with total hip arthroplasty. Prasad et al. reported that among elderly patients with displaced femoral neck fractures, the bipolar hemiarthroplasty group had a mean Modified Harris Hip Score of 83.85 ± 6.62 at 24 months, while the total hip replacement group had a score of 88.00 ± 5.76, with no statistically significant difference (p=0.067).¹³ This suggests that bipolar hemiarthroplasty can provide satisfactory functional recovery in appropriately selected elderly patients despite the theoretical functional advantages of total hip arthroplasty. Other Indian data have similarly shown reasonable functional restoration after bipolar hemiarthroplasty. In a prospective comparison of cemented bipolar prosthesis and total hip replacement, the bipolar group demonstrated acceptable Modified Harris Hip Scores during follow-up, although total hip replacement achieved significantly higher scores at 6, 12 and 24 months.¹⁴ These findings indicate that while total hip arthroplasty may provide superior function in selected active elderly patients, bipolar hemiarthroplasty remains an effective treatment where shorter surgical duration, lower operative burden and earlier mobilization are important considerations. The present study also demonstrated that only 10% of patients had poor functional outcomes. Pain remains an important determinant of Harris Hip Score following hemiarthroplasty. Studies comparing different prosthetic designs and fixation techniques have shown that functional outcome is influenced not only by implant choice but also by age, pre-fracture activity, comorbidity burden, surgical technique and postoperative rehabilitation. Elmenshawy and Salem, in their review of cemented versus cementless bipolar hemiarthroplasty, concluded that both techniques can provide satisfactory functional outcomes, although differences exist in perioperative risks and implant-related complications.¹⁵ Longer-term evidence further supports the durability of bipolar hemiarthroplasty. von Roth et al. followed 376 cemented bipolar hemiarthroplasties and reported a 20-year cumulative revision incidence of only 3.5%, with revision for aseptic loosening of 1.4%, indicating that the procedure can provide durable reconstruction in elderly patients.¹⁶ Although the present study had only a six-month follow-up, the high proportion of favourable early outcomes suggests that satisfactory initial functional restoration was achieved. Hemiarthroplasty has also shown functional advantages over internal fixation for displaced femoral neck fractures in elderly patients. Frihagen et al., in a randomized trial of 222 patients, reported that the hemiarthroplasty group had Harris Hip Scores 8.2 points higher at 4 months (p=0.003) and 6.7 points higher at 12 months (p=0.01) than the internal fixation group. Complications were also substantially lower with hemiarthroplasty (15% vs 50%; p<0.001).¹⁷ These findings reinforce the rationale for prosthetic replacement in elderly patients where rapid return to mobility is a principal treatment objective. The favourable early recovery observed in our study is also consistent with more recent evidence. A 2026 prospective observational study of primary bipolar hip arthroplasty found that age was negatively correlated with Harris Hip Score (r = −0.379, p=0.007), emphasizing that increasing age adversely affects postoperative mobility and functional recovery.¹⁸ This may partly explain why the present cohort, with a relatively lower mean age of 69 years compared with many Western studies, achieved 67.5% good-to-excellent outcomes. Overall, the present findings indicate that bipolar hemiarthroplasty provided satisfactory short-term functional restoration in elderly patients with intracapsular femoral neck fractures. More than two-thirds achieved good-to-excellent Modified Harris Hip Scores, half were able to walk without support, more than half had no limp, and three-fourths achieved a good range of hip movement. The results are broadly comparable with published national and international studies and support bipolar hemiarthroplasty as an effective treatment option for restoring mobility and functional independence in appropriately selected elderly patients.

Bipolar hemiarthroplasty provided satisfactory short-term functional outcomes in elderly patients with intracapsular fracture neck of femur. At six months, 67.5% of patients achieved good-to-excellent functional outcomes, comprising 52.5% excellent and 15% good results, while only 10% had poor outcomes. Half of the patients were able to walk without any support, and more than half had no residual limp. Furthermore, 75% demonstrated a good range of hip movements following surgery. These findings indicate that bipolar hemiarthroplasty was effective in achieving pain relief, early mobility and restoration of functional independence in appropriately selected elderly patients. Residual hip or thigh pain was an important contributor to poor functional outcome. Overall, bipolar hemiarthroplasty represents an effective treatment option for intracapsular fracture neck of femur in elderly patients, providing favourable early functional recovery with acceptable mobility at six months.

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