Uncemented hemiarthroplasty may have a role in the treatment of unstable intertrochanteric fractures in elderly patient. A survival complications and functional outcomes analysis.

Abstract

Background: Fractures of the proximal femur account for 30% of all fractures requiring surgical treatment. The optimal treatment for per- and intertrochanteric fractures, particularly associated with trochanter instability, is still open to debate. For these reasons, some authors have recently supported the use of bipolar arthroplasty or hemiarthroplasty as a treatment capable of reducing the risk of complications and obtaining a better functional result. The purpose of this study was to evaluate the functional and clinical outcomes at minimum six months of follow up of bipolar hemiarthroplasty as the primary treatment for intertrochanteric fracture in older patients. A secondary objective was to study the risk of early and intraoperative complications.

Methods: From November 2020 to April 2022, 102 patients with lateral proximal femur fracture underwent surgical operation with implant of a long-stemmed bipolar hemiarthroplasty. 86 patients were enrolled. The average age at the time of fracture was 87.4 ± 4.6 (range 77-98) years. Of the patients, 76.7% were female. For all patients intra- and perioperative data were extracted. All available patients were evaluated at a minimum 6-months follow-up to investigate: Charlson Comorbidity Index, autonomy (Barthel Index), use of walking aids (Koval Grade), memory quality or dementia (Mental Score), subsequent hospitalizations for surgical operations relating to the operated hip.

Results: The average time from trauma to surgery was 1 ± 0.7 days. The surgical time was 78.9 ± 21.9 minutes. At least one cerclage was used in 73.3% of patients. 87.5% of patients were verticalized on the first day. The average hospitalization time was 5.5 ± 2.9 days. During follow-up 20 deaths occurred, with a distance to surgery of 6.6 ± 7.2 (range 0.3-22.7) months. Six months after surgery, out of 86 patients, 12 deaths occurred, corresponding to 13.95%. 12 months after surgery, out of 57 patients, 15 deaths occurred, corresponding to 26.31%.

Conclusions: Long stemmed bipolar hemiarthroplasty following intertrochanteric fracture can be considered a safe procedure, especially in patients over 80 with associated comorbidities and short life expectancy.