Stabilizing the Unstable: Cone Hemiarthroplasty in Geriatric Intertrochanteric Fractures

Abstract

Background

Unstable intertrochanteric fractures in the elderly pose a significant treatment challenge due to poor bone quality, comminution, and associated comorbidities. Bipolar hemiarthroplasty offers the advantage of early mobilization and reduced fixation-related complications. This study evaluates short-term outcomes of bipolar hemiarthroplasty using an uncemented titanium fluted, tapered cone femoral prosthesis in such fractures.

Methods

A retrospective analysis was conducted on 43 consecutive elderly patients treated with uncemented bipolar hemiarthroplasty using a tapered, fluted cone stem between June 2023 and July 2024. Radiographic parameters—including stem subsidence, greater trochanter union, and limb-length discrepancy—were assessed at serial follow-ups. Functional outcomes were evaluated using the Harris Hip Score.

Results

Of the 43 patients operated on, 40 completed a minimum of 12 months follow-up. Greater trochanteric union was observed in 97.7% of cases, with one persistent nonunion causing abductor weakness and early dislocation. Mean stem subsidence was 3.5 mm (0.5–20 mm), with all settling occurring within the first 3 postoperative months; 4 patients (9.3%) experienced subsidence of 5 mm or more, including one requiring revision. The mean limb-length discrepancy was 4.7 mm (1–10 mm). At final follow-up, the mean Harris Hip Score among surviving patients was 91.28, with 29 patients (72.5%) achieving excellent outcomes and 11 patients (27.5%) achieving good outcomes.

Conclusions

Bipolar hemiarthroplasty using a tapered, fluted cone stem appears to be a reliable option for carefully selected elderly patients with unstable intertrochanteric fractures, offering predictable fixation, early weight-bearing, and favorable short-term functional results.