Cemented Bipolar Hemiarthroplasty versus Proximal Femoral Nails: A Prospective Comparative Outcome Analysis in Unstable Elderly Intertrochanteric Fractures

Introduction: Hip fractures always cause short-term pain, disability and a longer-term pain, disability or Deformity. Only a small number of reports on the incidence of hip fractures in the Asian population exist. Intertrochanteric fractures in osteoporotic bones with gross comminution are highly unstable and are associated with a high risk of morbidity and mortality. Material and Methods: To compare the functional and clinical outcomes of cemented bipolar arthroplasty and proximal femoral nailing in unstable intertrochanteric fractures, this multicenter prospective study was initiated from Aug’12 to Dec’14on 70 patients with unstable (Evans type III and IV) intertrochanteric fractures with minimum 2 years follow-up. Harris Hip Score was used to assess functional outcome. Results: Out of 70 patients, independent full weight bearing and return to pre-fracture activity levels was early in arthroplasty group i.e.1.2(p<0.001) and 5.4(p<0.01) weeks respectively as compared to PFN group i.e.8.2 and 10.2 weeks respectively was significantly earlier in patients with bipolar arthroplasty group. Postoperative complications were lower in the arthroplasty group. Hip scores at 3 months in arthroplasty and PFN group was 80.55 and 68.89(p<0.001); at 24months, 86.46 and 75.91(p<0.01) respectively. Conclusion: Primary cemented hemiarthroplasty in unstable elderly hip fractures is reliable, technically simple and a safe procedure. It has a major advantage of allowing early mobilisation, immediate full weight bearing, rapid rehabilitation, shorter hospital stay and early return to work. Cemented arthroplasties are advantageous in non-union and high risk patients suffering from psychiatric illness in preventing peri-prosthetic dislocations and fractures.