Primary Cemented Bipolar Hemiarthroplasty Versus Proximal Femoral Nail Fixation for Unstable Intertrochanteric Fractures in Osteoporotic Elderly Patients: A Prospective Observational Study

Introduction Unstable intertrochanteric fractures in osteoporotic elderly patients are associated with substantial morbidity, delayed mobilization, and risk of fixation failure. The optimal surgical treatment remains debated. This study evaluated functional outcomes and implant-related complications in elderly patients with unstable intertrochanteric fractures treated with either primary cemented bipolar hemiarthroplasty (BHA) or proximal femoral nail (PFN) fixation. Methods This prospective observational study was conducted at a tertiary care orthopedic center between April 2022 and June 2025. Sixty patients aged 60-80 years with unstable intertrochanteric fractures (Evans types III and IV) were included. Patients underwent either cemented BHA (n=30) or PFN fixation (n=30) as determined by the treating surgical team. Primary outcome measures included time to full weight-bearing (FWB), Harris Hip Score (HHS) at one year, and revision surgery rate. Secondary outcomes included Parker-Palmer Mobility Score and limb length discrepancy (LLD). Results Patients treated with BHA achieved FWB significantly earlier than those treated with PFN (5.87±3.97 days vs. 12.83±1.62 days; p<0.001). At the one-year follow-up, the BHA group demonstrated significantly higher mean HHS (89.44±4.69 vs. 85.79±8.26; p=0.048) and Parker-Palmer Mobility Scores (8.15±0.95 vs. 7.38±0.86; p=0.002). Revision surgery was required in one patient (3.3%) in the BHA group and four patients (13.3%) in the PFN group. LLD greater than 10 mm was observed in three patients (10%) following BHA and in none of the PFN patients. Conclusions In this prospective observational study, patients managed with primary cemented BHA demonstrated earlier postoperative mobilization and better functional outcomes at one year compared with those treated with PFN fixation. These findings suggest that hemiarthroplasty may be a useful treatment option in selected elderly patients with unstable intertrochanteric fractures where rapid rehabilitation is a major treatment objective.