Clinical Outcome of Cemented Bipolar Hemiarthroplasty in AO Type II and Type III Peritrochanteric Fractures of the Femur in Elderly Patients: A Prospective Clinical Study

Abstract

Background: Peritrochanteric fractures in elderly osteoporotic patients are associated with significant morbidity, prolonged immobilization, and increased mortality. Internal fixation in unstable fractures often results in complications such as implant failure and delayed rehabilitation. Cemented bipolar hemiarthroplasty has emerged as an alternative treatment that facilitates early mobilization and functional recovery. This study aimed to evaluate the clinical outcomes of cemented bipolar hemiarthroplasty in elderly patients with AO Type II and Type III peritrochanteric fractures, while assessing functional outcomes, re-surgery rates, mortality, and limb length discrepancies.

Methods: A prospective longitudinal study was conducted at the Department of Orthopaedics, JSS Academy of Higher Education and Research, Mysuru, over 18 months (November 2019–May 2021). Thirty patients aged ≥65 years with AO Type II or Type III peritrochanteric fractures underwent cemented bipolar hemiarthroplasty. Functional outcome was assessed using the MHHS (Modified Harris Hip Score) at regular follow-up intervals up to one year. Demographic details, perioperative variables, complications, limb length discrepancy, ambulation time, duration of hospitalization, and mortality were recorded. Statistical analysis was performed using SPSS version 18.0, with p<0.05 considered statistically significant.

Results: The mean age of the participants was 73.4 ± 8.3 years, with females comprising 63.3% of the study population. Trauma was the predominant mode of injury (80%), and hypertension was the most common comorbidity (46.7%). The mean MHHS was significantly higher in Type II fractures than Type III fractures (86.0 ± 3.96 vs. 81.36 ± 5.77; p=0.016). Overall, 76.7% of patients achieved good functional outcomes, 6.7% had excellent outcomes, and 13.3% had fair outcomes. Patients were mobilized after a mean of approximately 4 days, with an average hospital stay of about 8 days. Complications occurred in 26.7% of patients, mainly superficial infections (13.3%) and bed sores (10%), while one intraoperative mortality (3.3%) was reported. No patient required revision surgery, and limb shortening was generally less than 2 cm.

Conclusion: Cemented bipolar hemiarthroplasty provides satisfactory functional outcomes, early ambulation, and effective rehabilitation in elderly patients with AO Type II and Type III peritrochanteric fractures. The procedure demonstrated low re-surgery rates, acceptable complication rates, and favorable postoperative recovery, making it a reliable treatment option for unstable osteoporotic peritrochanteric fractures. Larger randomized controlled trials are recommended to further validate these findings.