Single-center Midterm Outcomes of Primary Cemented Modular Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures in the Indian Population

Introduction: Intertrochanteric (IT) fractures account for approximately 45% of all hip fractures in elderly individuals. Over the last century, sliding hip screws and proximal femoral nailing have emerged as reliable methods for the fixation of these fractures. However, comminution and osteoporosis, especially in unstable fractures, present challenges in the osteosynthesis of IT fractures. Varus collapse, screw cutout and non-union are frequently associated problems. The existing comorbidities and high mortality and morbidity associated with these fractures complicate the situation further. This has led to the rising trend of primary hemiarthroplasty as an alternative to osteosynthesis in unstable IT fractures. We aimed to study the outcomes of primary cemented modular bipolar hemiarthroplasty in unstable IT femoral fractures in the Indian population. Materials and Methods: Fifty-four patients admitted to a tertiary care hospital with a diagnosis of unstable IT fractures (AO/OTA 31-A2) underwent cemented modular bipolar hemiarthroplasty with/without stainless steel wire augmentation as a primary procedure from January 2020 to June 2022. All patients were followed up for a minimum period of 1-year postsurgery. Clinical, functional, and radiological outcomes were assessed at 3, 6, and 12 months postoperatively and every 6 months thereafter. Results: The mean age of the population was 71.84 ± 3.17 years. A total of 40.75% were males and 59.25% were females. The mean surgical time was 76 ± 10.7 min, and the mean blood loss volume was 350 ± 63.8 ml. The mean duration of hospitalization was 5.16 ± 2.67 days. One patient died in the immediate postoperative period, and two patients were lost to follow-up after 3 months. The mean follow-up duration was 17.84 ± 4.09 months. At the end of 1 year, the mean Harris hip score (HHS) was 84.35 ± 8.3 for 54 patients, of whom excellent functional outcomes were observed in 17 hips (30.9%), good HHSs were reported in 28 hips (50.9%), and fair HHSs were reported in 9 hips (16.4%). Poor outcomes were observed in one patient who had two episodes of dislocation and required revision surgery at 3 months. Conclusion: “Cemented modular bipolar hemiarthroplasty, when performed as a primary procedure for elderly patients (over 60 years) with unstable IT fractures in the context of osteoporosis, comminution, and multiplanar splits, has proven to be an excellent treatment option. The procedure offers significant benefits, including earlier weight-bearing, reduced risk of reoperation, and excellent functional outcomes, enabling patients to return to their preinjury activity level more quickly.”