Caregiver burden and patient quality of life after hip fracture surgery: A comparison of proximal femoral nailing and bipolar hemiarthroplasty

Aims: Hip fractures are frequently associated with loss of independence and increased caregiver burden during the postoperative period.This study aimed to compare patient quality of life and caregiver burden after bipolar hemiarthroplasty and proximal femoral nailing (PFN) in patients undergoing surgery for hip fractures, and to evaluate factors associated with caregiver stress during the postoperative period. Methods:In this retrospective comparative study, caregivers of patients operated for femoral neck or intertrochanteric fractures between January 2023 and January 2025 were evaluated.A total of 132 patient-caregiver pairs were included: bipolar hemiarthroplasty (Group 1, n=64) and PFN (Group 2, n=68).Recorded caregiver variables included age, sex, relationship to the patient, daily caregiving time, positioning stress, and fear of damaging the implant.Patient outcomes included assisted/unassisted ambulation time, time to independence, EuroQol 5-dimension 5-level (EQ-5D-5L), and Zarit caregiver burden scale scores.Results: Assisted and unassisted mobilization occurred earlier in Group 1 than in Group 2 (p<0.001 for both comparisons).Positioning stress was higher in Group 1, whereas fear of damaging the implant was higher in Group 2 (p=0.020 and p=0.030).Greater deterioration in EQ-5D-5L scores and higher Zarit burden scores between baseline and 3 months were observed in Group 2 (p=0.020 and p=0.006).Between 6 and 12 months, Group 2 showed significant improvement in quality of life and caregiver burden (p=0.020 and p=0.001, respectively).Between-group differences had largely diminished by one year.Conclusions: Earlier mobilization and lower early caregiver burden were observed in the bipolar hemiarthroplasty group.However, caregivers in this group reported higher anxiety during transfers and repositioning.In the PFN group, early recovery was relatively slower and caregiver burden was more pronounced; nevertheless, significant improvement was observed during follow-up.These findings suggest that success after hip fracture treatment should be evaluated not only by surgical outcomes, but also by patient independence and caregiver burden.