Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

Abstract

intertrochanteric fractures (itfs) in the elderly are still a big challenge for clinical doctors. Although proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) are selected by most of the orthopaedic surgeons for elderly ITFs patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in elderly. In this study, we hypothesized that BPH should not be selected as the primary option for ITFs in elderly patients, and analyzed clinical data of 202 elderly ITFs patients aged 80 years or more treated with PFNA (Group A) and BPH (Group B) to compare the early outcome of PFNA and BPH for ITFs in elderly patients aged 80 years or more. We found that operation time and blood loss during surgery in group A are less than in Group B. Time of weight bearing after operation in Group A is longer than in Group B. Incidence of complications 2 weeks after operation in Group A is 9.29% less than 25.81% in Group B (χ 2 = 9.539, p = 0.002). Mortality rates 12 months after operation in Group A is 11.43% similar with 19.35% in Group B (χ 2 = 2.261, p = 0.133). Harris Hip Score 12 months after operation in Group A is 68.00 ± 29.11 points similar with 65.73 ± 33.29 points in Group B (t = 0.490, p = 0.625). Therefore, for elderly ITFs patients aged 80 years or more, BPH should not be selected as the primary option for itfs in elderly patients.

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

“…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).…”

Fixation stability scoring in inter-trochanteric femur fractures treated with osteosynthesis: A retrospective observational study

“…Nonetheless a successful osteosynthesis is superior to hip replacement in view of faster surgery preserving the native hip, reduced blood loss, lesser wound complications, lesser chances of limb length discrepancies, reduced post operative morbidity and mortality rate. 13,14 Studies have proven that, intra medullary nails perform better than extra-medullary implants in case of unstable fractures. 15,16 Some authors still prefer extra-medullary fixation in stable intertrochanteric fractures, given the reasons that intra-medullary devices are relatively newer with a learning curve, technically demanding and costlier than extra-medullary devices.…”

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

“…The patients were divided into 2 groups as those who underwent LFS-BPH and PFN. The groups were evaluated in terms of total hospitalization time, operation time, amount of blood transfusion, time until the patient walked independently, presence of deep vein thrombosis in the postoperative period, development of decubitus wounds, and Harris hip scores [8]. Deep vein thrombosis was evaluated with Doppler USG, decubitus ulcers were clinically diagnosed, and the hip scores of both groups were calculated using the Harris hip score at the 6 th postoperative month.…”

“…Despite this union rate, hemiarthroplasty is performed by many surgeons [7]. ITF surgery is still controversial, especially in older patients [8].…”