Retrospective analysis of the incidence and risk factors for mortality from intertrochanteric fracture in elderly patients treated with cementless bipolar hemiarthroplasty:2-year follow-up

Abstract Purpose: The objective of this study was to explore the risk factors for mortality in elderly patients with intertrochanteric fractures treated with proximal femoral nail fixation(PFNA) or cementless bipolar hemiarthroplasty(CBH), as well as in patients with CBH based on subgroups of follow-up time. Patients and Methods: A total of 231 patients who underwent PFNA or CBH at our hospital between January 2016 and October 2021 were included. We first compared the two surgical procedures, and then compared the mortality and survival groups treated with CBH based on the subgroups of follow-up time in univariate, logistic regression, and Kaplan-Meier survival estimates Results: In our study, the survival rate and average survival time of the joint replacement group were greater than those of the intramedullary nailing group(p＜0.05), and the time from surgery to implantation in the joint replacement group was significantly shorter(p＜0.05). However, the need for blood transfusion was greater in the joint replacement group(p＜0.05), and the Harris score of the joint replacement group was also greater than that of the intramedullary nailing group(p＜0.05). The survival rates in the CBH group at the 6-month, 1-year and 2-year follow-ups were 90.4%, 84.2% and 78.9%,respectively.Univariate analysis of the CBH group showed that gender was associated with mortality at the 6-month(p＜0.05), 1-year(p＜0.05), and 2-year follow-ups(p＜0.05), and we found that ICU admission time was a risk factor for mortality at both 1-year and 2-year follow-ups(p＜0.05), which was also consistent with the logistic regression analysis. Conclusion: Gender was an independent risk factor for mortality in all follow-up time subgroups. In addition, the amount of perioperative hemoglobin and albumin loss should be considered and measures should be taken during the perioperative period. Level of Evidence:therapeutic level III according to the OCEBM levels of the Evidence Working Group.