Modes of failure of hip hemiarthroplasty for femoral neck fracture.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Competing interests: T. Tung and E. Trepman received fellowship support from the Concordia Foundation, DePuy Synthes, and Smith & Nephew. T. Gascoyne, E. Bohm, C. Burnell, D. Hedden, and T. Turgeon have received institutional funding from DePuy, Smith & Nephew, Zimmer Biomet, Hip Innovation Technology, and Össur. E. Bohm is a consultant to Stryker Canada and declares receiving payment for expert testimony from the Government of British Columbia. He is also an editorial board member of The Bone and Joint Journal. C. Burnell reports travel reimbursement from Hip Innovation Technology. D. Hedden was a paid consultant for Smith & Nephew. No other competing interests were declared. 5. Indian J Orthop. 2025 May 20;59(8):1026-1031. doi: 10.1007/s43465-025-01413-6. eCollection 2025 Aug. When to Think and Do Bipolar in Inter Trochanteric Fractures. Rajnish RK(1), Yadav SK(1), Jacob AM(1), Srivastava A(2), Gupta S(1), Elhence A(1). Author information: (1)Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India. (2)Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India. BACKGROUND: The life expectancy of the elderly population is increasing; hence, a rise in both intracapsular and extracapsular hip fractures. Early surgical intervention and ambulation are crucial to improving outcomes and reducing complications associated with recumbency. The optimal management of intertrochanteric femur fractures (IFFs) in elderly patients especially in cases of osteoporotic bone or high-risk fractures remains debated. Intramedullary fixation is most commonly used but may fail in patients with poor bone quality, making bipolar hemiarthroplasty (BHA) a potential alternative. OBJECTIVES: This review aims to evaluate the role of BHA in the management of IFFs in elderly patients, identifying fracture patterns amenable to BHA. METHODS: A comprehensive literature review on BHA for IFFs in elderly patients was performed, focusing on indications, surgical techniques, and outcomes. RESULTS: BHA can be considered beneficial for elderly patients with osteoporotic IFFs at high risk for fixation failure, particularly in fractures with severe comminution, reverse oblique patterns, or associated intraarticular pathologies. There is no consensus on definitive indications for BHA, with surgeon preference and fracture morphology guiding treatment decisions. The surgical technique varies, with approaches including posterolateral, direct lateral, and direct anterior methods. Cemented and uncemented femoral stems both have advantages and limitations, with cemented stems favoured for immediate weight-bearing in osteoporotic bone. CONCLUSION: BHA is a viable alternative to intramedullary fixation in elderly patients with high-risk IFFs. Further studies are needed to define clear indications and optimal techniques for BHA in this population. © Indian Orthopaedics Association 2025. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. DOI: 10.1007/s43465-025-01413-6 PMCID: PMC12367598