Midterm outcome analysis of bipolar hemiarthroplasty for unstable intertrochanteric femur fractures: A retrospective study

Background: Recent advances in medical systems and technologies have resulted in increased survival after intertrochanteric fractures of the femur, requiring the selection of appropriate femoral stems considering mid- to long-term durations. We performed hip hemiarthroplasty for unstable intertrochanteric fractures using a Wagner cone femoral stem (Group A) and double tapering right angled femoral stem (C2 stem, Group B), and evaluated the clinical imaging results. Methods From January 2004 to December 2013, 79 patients (79 hips) who underwent hip hemiarthroplasty with a cone stem (36 cases) and C2 stem (43 cases) were included. During the follow-up period, clinically, changes in pain (visual analog scale [VAS] score), walking ability, and Harris Hip score were examined. Radiologically, changes in the proximal femur were observed. We also reviewed the complications that occurred. Results Patients’ mean ages were 77.2 (70-83) years and 78.6 (70-84) years, and mean follow-up periods were 84.7 (60-108) months and 85.4 (60-96) years in Groups A and B, respectively. Postoperative pain (VAS score) and the Harris hip score were not significantly different between the groups until 24 months and 36 months, respectively. However, VAS scores from 36 months postoperatively and Harris hip scores from 48 months postoperatively indicated that Group B patients had significantly higher VAS scores and lower Harris hip scores. There was no significant difference in walking ability between the groups; however, in Group B, walking ability was reduced by one grade in 13 patients and by two grades in nine. Cortical bone osteoporosis occurred in four and 14 cases in Groups A and B, respectively. In Group B, five patients developed cortical bone resorption, and four of them had nonunion of trochanteric fracture fragments. Conclusions Hip hemiarthroplasty using a cementless femoral stem for unstable intertrochanteric fractures requires careful selection of the stem, considering the remaining life of the patient. When using a 3C stem for unstable intertrochanteric fractures, it is thought that the firm fixation of fractured trochanteric fragments is necessary, and for a reverse oblique fracture, it is better to use the 3B stem with a suitable length.