Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

Abstract

This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more. This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared. There are no statistically significant differences when compared general data in patients from group A and B ( P > .05). Operation time in Group A is less than Group B (103.33, 40–230 min vs 122.64, 75–180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50–100 mL vs 194.44, 100–500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7–100 days vs 6.67, 4–14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0–91 points vs 64.41, 0–90 points, P > .05). Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.

Comparison of proximal femoral nail and hemiarthroplasty outcomes in elderly (over 80 years old) patients with intertrochanteric fractures

“…The prolongation of the operation duration and the deterioration of hemodynamics due to bleeding cause an increased need for postoperative intensive care. According to the studies performed, blood loss and blood transfusion need are higher with hemiarthroplasty [17,19]. In our study, when the ratio of patients who needed postoperative intensive care was examined, no significant difference was found between the two groups.…”

“…Some studies did not find a significant difference in mortality rates within the first year [12,16]. In the study of Kumar et al [17] and other similar studies [18,19], patients with advanced age were evaluated as in our study, and no significant difference was found between the two groups in terms of mortality in the first year. In our study, the mean day of death in the PFNA group was 88 days, whereas it was 41.5 days in the hemiarthroplasty group (not given in the text).…”

Evaluation of patients’ post-operative results operated for hip fracture with computerized dynamic posturography: Proximal femoral nailing versus hip arthroplasty

“…Mortality rates 12 months after operation in PFNA were similar with BPH and HHS 12 months after operation in PFNA was similar with BPH. [ 21 ] Vestergaard et al found that patients with arthroplasty had a significantly higher mortality rate compared to patients with PFN. [ 22 ] In the meta-analysis of Cui et al on the application of either hemiarthroplasty or internal fixation in the treatment of elderly patients with femoral neck fractures, there was no significant difference between the two treatments in terms of mortality.…”

İntertrokanterik Femur Kırığı Tedavisinde Proksimal Femoral Çivileme ve Bipolar Hemiartroplasti Tekniklerinin İntraoperatif ve Postoperatif Sonuçlarının Karşılaştırılması

“…So, we may say that the BHA method is a disadvantageous technique for hip fracture repair in general. Tan et al (13) have also reported significantly high postoperative complication and mortality rates in patients who underwent BHA and therefore suggested not to select BHA as a primary option in trochanteric fractures in the elderly. In their systematic review, Kumar et al ( 14) also suggested the PFN method in elderly patients as a safer surgical technique.…”