Cementless bipolar hemiarthroplasty compared with proximal femoral nail anti-rotation of unstable intertrochanteric fractures in senile patients with osteoporosis: a retrospective study

Abstract

Background: Implant design for the correction of osteoporotic unstable intertrochanteric fractures in elderly patients is a controversial issue. Our study aims to compare the efficacy of PFNA and cementless bipolar hemiarthroplasty (CBH) in treating osteoporotic unstable intertrochanteric fractures in the elderly.

Methods: We retrospectively assessed 70 elderly patients, aged > 70 years old, with intertrochanteric fractures (AO/OTA 31-A2 fractures) from 2014 to 2019. Among them, 34 patients received PFNA and 36 patients received CBH, accompanied with 2-year follow-ups. Additionally, the efficacy difference between the two implants was compared.

Results: Both groups had similar general variables like age, gender, fracture site, degree of osteoporosis, fracture classification, ASA score, basic diseases, preoperative preparation time, anesthesia mode, amount of postoperative blood loss, hospital length of stay, along with postoperative blood transfusions and postoperative complications (P > 0.05). Conversely, significant differences were observed among intraoperative variables (amount of blood loss, amount of blood transfusions, operative time, number of intraoperative fluoroscopy), postoperative variables (weight-bearing time out of bed), and Harris hip function score within 12 months of operation (P < 0.05).

Conclusions: CBH showed no obvious advantage over PFNA in the perioperative period in elderly patients with osteoporotic unstable intertrochanteric fractures. However, the joint replacement allowed for earlier ambulation after the operation and rapid recovery of the hip joint function.

Keywords: Elderly; Hemiarthroplasty; Osteoporosis; Proximal femoral nail anti-rotation; Unstable intertrochanteric fracture.

Fig. 1

Case screening flow chart

Fig. 2

a The schematic sketch of PFNA prosthesis; b The schematic sketch of CBH prosthesis

Fig. 3

A 76-year-old female patient with left femoral intertrochanteric fracture, caused by a fall while walking (AO classification: 31-A2.2). PFNA was performed. a Preoperative pelvic anteroposterior X-ray illustrating a left femoral intertrochanteric fracture. b Three-dimensional CT reconstruction of the pelvis showing the lateral image of the left hip joint, and the greater trochanter fracture block is clearly visible. c Three-dimensional CT reconstruction of the pelvis demonstrating the anteroposterior image of the left hip joint, and the lesser trochanter fracture block is clearly visible. d Postoperative pelvic anteroposterior X-ray images. e Postoperative left hip anteroposterior X-ray images. f Postoperative left hip lateral X-ray images

Fig. 4

A 77-year-old female patient with right femoral intertrochanteric fracture caused by a fall while walking (AO classification: 31-A2.3). CBH was performed. a Preoperative pelvic anteroposterior X-ray illustrating a right femoral intertrochanteric fracture. b Three-dimensional CT reconstruction of the pelvis showing the lateral image of the right hip joint, and the greater trochanter fracture block is clearly visible. c Three-dimensional CT reconstruction of the pelvis showing the anteroposterior image of the right hip joint, and posterior wall of femoral trochanter and the lesser trochanter fracture blocks are clearly visible. d Postoperative pelvic anteroposterior X-ray images. The greater trochanter and the posterior wall of femoral trochanter fracture blocks were bound with steel wire. e Postoperative right hip anteroposterior X-ray images. f Postoperative right hip lateral X-ray images