The comparison of outcomes of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement design, in treatment of femur intertrochanteric fractures

Purpose: In this study; we compared the short term results of mortality rates of 127 patients with intertrochanteric femoral fracture who were treated with Proximal Femoral Nail- Antirotation (PFNA) or cemented, bipolar hemiarthroplasty with calcar replacement design, retrospectively. We also compared length of operation, amount of blood transfusion during operation, hospital stay, functional outcomes, quality of life, complication and revision rates and the cost of surgery in 92 out of 127 patients who were alive, reached minimum 12 months follow-up and mobile before the trauma.Materials and Methods: The total mortality, mortality during surgery and mortality in specific months were compared in 127 patients who were admitted to our clinic between January 2008 and December 2010. 92 out of 127 patients who were alive, reached minimum 12 months follow-up and mobile before trauma were compared, retrospectively. The comparements were anesthesia risk (ASA Score), type of anesthesia, length of operation, blood transfusion during operation, hospital stay, functional outcomes (Harris Hip Score), quality of life (Short Form-36), complication and revision rates and the cost of surgery.Cause of injury and the type of fracture according to OTA classification were determined from patient records and radiographs, retrospectively.Results: 45 (%35.4) of the 127 patients were treated with PFNA and 82 (%64.6) were treated with cemented, bipolar hemiarthroplasty with calcar replacement design. 11 (%24.4) of 45 patients in the PFNA group and 24 (%29.3) of 82 patients in the hemiarthroplasty group died. There was no significant difference between the groups according to total mortality rate, mortality during surgery and mortality in specific months.We compared the other parameters in 92 patients who were alive, reached minimum 12 months follow-up and mobile before trauma. 34 (%37) patients were treated with PFNA, 58 (%63) patients were treated with cemented, bipolar hemiarthroplasty with calcar replacement design. In total 64 (%69.6) of 92 patients were female, 28 (%30.4) were male. The average age was 80.24 (55-94) years during surgery and the average follow-up time was 27.23 (12-47) months.There was no significant difference between the groups in terms of age and gender.The fracture was caused by home injuries in the form of falls in 47 (%51.1) patients, falls outside the homes in 35 (%38) patients, pedestrian traffic accidents in 3 (%3.3) and as car passengers in 3 (%3.3) patients and finally, falls from a height in 4 (%4.3) patients.Fall from a height and road traffic accident as a passenger were more frequent causes in the PFNA group. The other causes were more frequent in hemiarthroplasty group.According to OTA classification in fracture type, there was no significant difference between the groups.There was no significant difference between the groups in terms of ASA Score and the type of anesthesia.The average of operation time was 54.85 (40-110) minutes in the PFNA group, and 74.66 (55-120) minutes in the hemiarthroplasty group. The operation time was shorter in the PFNA group. Likewise, the amount of erytrocyte transfusion was less in the PFNA group.Average hospital stay was 5.91 (5-12) days in the PFNA group and 9.41 (6-16) days in the hemiarthroplasty group. Hospital stay was shorter in the PFNA group.The average Harris Hip Score was 82.38 in the PFNA group and 78.34 in the hemiarthroplasty group. Excellent-to-fine rate was %91.12 in the PFNA group and %81.03 in the hemiarthroplasty group, but there was no significant difference between the groups.According to Short Form-36 results; there was no significant difference between the groups in terms of Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Social Functioning (SF), Role-Emotional (RE) and Mental Health (MH); but Vitality (V) scores were better in the PFNA group.There was no significant difference between the groups in terms of complication and revision rates.The primary cost of surgery was less in the hemiarthroplasty group, but when the revision costs were added in the hemiarthroplasty group, we found no significant difference between the groups.Conclusions: The results show that both PFNA and cemented, bipolar hemiarthroplasty with calcar replacement design are good techniques in treatment of intertrochanteric femoral fractures. The treatment should be planned according to the surgeon?s experience and hospital conditions.