Comparison Between Cementless Bipolar Hemiarthroplasty and Proximal Femoral Nail Anti-Rotation for Unstable Intertrochanteric Femoral Fractures in the Elderly: A Retrospective Study

Background: Proximal femoral nail anti-rotation (PFNA) is the gold-standard treatment for intertrochanteric fractures in elderly patients. However, some authors have recently recommended the use of cementless bipolar hemiarthroplasty (CLBHA) for unstable intertrochanteric fractures and achieved satisfactory results. This study aimed to compare the results and mortality rate postoperatively five years between CLBHA and PFNA for unstable intertrochanteric fractures of the femur in elderly patients (age > 60 years). Methods: This retrospective study reviewed in and outpatient medical records and civil registrations between October 2012 and October 2017 at our hospital. In total, 122 patients (43 men, 79 women; aged 60–93 years) with unstable intertrochanteric femurs were treated. Fractures were divided into the CLBHA and PFNA groups. Differences in operative time, intraoperative bleeding, blood transfusion, ambulation-to-walk duration, postoperative hospitalization, postoperative complications and revision rate, ambulation at six months, and five-year mortality rate were collected. The unpaired t-test was analyzed using the χ2 test, and statistical significance was set at P < 0.05. The mortality rate is shown as an additional Kaplan–Meier estimate together with the p-value. Results: The operative time (67.8±24.21 vs. 57±3.22 min, P =0.028), ambulation-to-walk duration with a gait aid (12.47±9.41 vs. 9.02±7.59 days, P <0.001), and postoperative hospitalization (911.55±6.61 vs. 7.11±3.45 days, P =0.037) were significantly different between the CLBHA and PFNA groups. Intraoperative bleeding, blood transfusion, postoperative complication, revision rate, ambulation at six months, and five-year mortality rate had no statistically significant differences. Conclusions: Although CLBHA showed a longer surgical period, longer postoperative hospitalization, and slower ambulation compared to PFNA, the results showed no statistically significant difference in long-term outcomes and five-year mortality between both procedures for intertrochanteric femoral fractures in the elderly. Moreover, although PFNA remains the gold-standard treatment, CLBHA can be used as an alternative procedure in certain situations; however, the choice of procedure should depend on individual patient factors and surgeon expertise.