Comparative mid-term outcomes of hemiarthroplasty and internal fixation in treating senile femoral intertrochanteric fractures: a retrospective cohort study

Objective This study aimed to compare the medium-term efficacy of hemiarthroplasty (HA) versus internal fixation (IF) in treating senile femoral intertrochanteric fractures and analyze their postoperative mortality and risk factors. Methods A retrospective analysis was conducted on 192 elderly patients with unilateral femoral intertrochanteric fractures. Among these, 117 patients received IF, while 75 underwent HA. Comparisons were made between the two groups regarding operation time, hospital stay, blood transfusion rate, incidence of postoperative complications, American Society of Anesthesiologists (ASA) grade, number of concomitant medical diseases, Harris hip score post-operation, postoperative mortality, and survival curve of follow-up endpoints. Univariate analysis and the Cox proportional hazards model were applied to identify risk factors for postoperative mortality. Results The HA group exhibited significantly lower incidence of postoperative complication and mortality rates compared to the IF group. At one-year post-operation, the HA group demonstrated superior Harris Hip Scores and better overall survival. Surgical method, ASA score, number of concomitant medical diseases, and postoperative blood transfusion rate were identified as significant factors influencing postoperative mortality in elderly patients with femoral intertrochanteric fractures. Furthermore, multivariate analysis confirmed that IF, a high ASA score, and the presence of multiple comorbidities were found to be independent risk factors for postoperative death. Conclusion In this retrospective cohort, hemiarthroplasty was associated with lower postoperative mortality, fewer complications, and better early functional recovery compared with internal fixation. These findings highlight the importance of considering surgical method, comorbidities, and ASA score as key factors in improving postoperative prognosis.