Hemiarthroplasty for Proximal Femoral Fractures in Centenarians: A Case Series With 12-Month Survival and Functional Outcomes

Background Hip fractures in centenarians are associated with high mortality, poor functional recovery, and substantial perioperative risk. Data specifically describing survival and functional outcomes after hemiarthroplasty in this exceptionally old population remain limited. Subjects and methods We conducted a retrospective descriptive case series of 16 patients aged 100 years and older with proximal femoral fractures who underwent hemiarthroplasty at Viet Duc University Hospital between January 2021 and January 2025. Patients were managed within a multidisciplinary care pathway incorporating orthogeriatric principles. Data collected included comorbidity burden, pre-injury mobility and functional status, perioperative characteristics, postoperative complications, survival, and functional outcomes. Survival status, mobility, and functional independence were assessed at 1, 3, and 12 months after surgery. Functional outcomes were assessed among surviving patients at each follow-up time point. Results The mean age was 101.75 ± 1.88 years, and 93.75% of patients were female. Before injury, the mean Parker Mobility Score was 4.06 ± 0.92 and the mean Barthel Index was 81.56 ± 7.47. The mean time from admission to surgery was 45.38 ± 15.28 hours. Delirium was the most common postoperative medical complication (37.50%), followed by pneumonia (12.50%), and no in-hospital deaths were recorded. Cumulative mortality was 6.25% at 1 month, 12.50% at 3 months, and 31.25% at 12 months. Among survivors, the mean Parker Mobility Score decreased to 1.47 ± 1.13 at 1 month and subsequently improved to 2.50 ± 1.87 at 3 months and 3.09 ± 2.26 at 12 months. The mean Barthel Index showed a similar pattern, decreasing to 36.00 ± 17.94 at 1 month and improving to 48.21 ± 24.54 at 3 months and 52.73 ± 25.43 at 12 months. Both measures remained below pre-injury levels at 12 months. Conclusions In this descriptive case series of centenarian patients selected for hemiarthroplasty, cumulative 12-month mortality was 31.25%. Among survivors, mobility and functional independence improved progressively after the first postoperative month but remained below pre-injury levels at 12 months. These findings highlight the importance of considering functional recovery alongside survival when evaluating outcomes in this exceptionally old patient population.