Functional Outcomes of Bipolar Hemiarthroplasty in Unstable Intertrochanteric Femur Fractures in the Elderly: A Prospective Study.

Background Intertrochanteric femur fractures are relatively common injuries among elderly individuals. Treatment options include fixation of intertrochanteric fractures using proximal femoral nails (PFNs), dynamic hip screws (DHSs), and unipolar and bipolar hemiarthroplasty. Unstable types of intertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen (AO) types 31-A2 and A3) are more common in elderly osteoporotic people. Intertrochanteric femur fractures having a subtrochanteric extension, comminution at the posteromedial cortex, and reverse obliquity are considered to be unstable. The purpose of the study is to evaluate the functional outcomes of an unstable intertrochanteric femur fracture treated with bipolar hemiarthroplasty as the primary treatment option. Aims and objectives This study aims to assess the functional outcomes of bipolar hemiarthroplasty in unstable intertrochanteric fractures in the elderly using the Harris Hip Score (HHS) and the Merle d'Aubigné and Postel Criteria. The time point of assessment was from August 2016 to August 2018. Material and methods Fifteen elderly patients with unstable intertrochanteric fractures of the femur were treated with cemented bipolar hemiarthroplasty. Patients with unstable femur fractures or with osteoporosis and age above 65 years were included in the study. Harris Hip Score and the Merle d'Aubigné and Postel Criteria were used to measure functional outcomes. Patients were followed up at the first, third, and sixth months and subsequently at the end of one year. Results The mean age of the patients was 78.73 years. The majority (11) of the patients were female (73%). The average operative time was 119 minutes, the average blood loss was 380 ml, the mean postoperative hospital stay was 12 days, and the average time taken for mobilization was four days. An average of 15 elderly patients with unstable intertrochanteric fractures of the femur were treated with cemented bipolar hemiarthroplasty. The HHS on the first follow-up was 42.44 (SD of 6.52), followed by a score of 64.43 (SD of 8.11) on the second follow-up, 82.32 (SD of 2.81) on the third follow-up, and 84.23 (SD of 3.15) on the fourth follow-up. Eleven patients had good results, and two had fair results at the one-year follow-up, according to the HHS. According to the Merle d'Aubigné and Postel Criteria, 11 patients had very good results, and two had moderate results at the one-year follow-up. The average Merle d'Aubigné score was 14.6 on the final follow-up after one year. Conclusion Bipolar hemiarthroplasty in an unstable intertrochanteric femur fracture in the elderly results in better functional outcomes, as it helps in early full weight-bearing mobilization, which significantly decreases complications of prolonged immobilization and can be safely considered in the treatment of unstable intertrochanteric fractures in elderly patients.

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Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, N. K. P. Salve Institute Of Medical Sciences & Research Centre And Lata Mangeshkar Hospital issued approval 21/2016. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.