Metaphyseal vs diaphyseal fixed-stem hemiarthroplasty in treating unstable intertrochanteric fractures in elderly patients

Abstract

Various surgical techniques have been defined for hip hemiarthroplasty (HA), including metaphyseal vs. diaphyseal and short stem vs. long stem. The present study aims to compare outcomes of metaphyseal fixed short-stem vs. diaphyseal fixed long-stem HA in treating unstable intertrochanteric fractures in elderly patients. This study was conducted retrospectively and included 129 patients ≥65 years of age, having unstable intertrochanteric fractures and undergoing HA. Outcome measures were the 2-year Harris hip score and the mobility score of Parker and Palmer; comorbidities as well as mortality rates of the groups were compared. Mean operation time and median full weight-bearing time were significantly shorter in group B (p<0.05 for both). As for the Harris hip scores, group B showed better outcomes for the third-month evaluation (p=0.006). However, 2-year assessments were similar (p=0.067). In addition, higher Parker and Palmer mobility scores were obtained in group B at the 2-year assessment (p<0.001). The frequencies of prosthetic dislocation, cortical porosis and subsidence were higher in group A (p<0.05 for all). The findings obtained in this study suggest that diaphyseal fixed long-stem HA seems to be superior to the metaphyseal fixed short-stem HA because the former is related to better functional scores, earlier mobilization, and lower complication rates.