• Irfan Muhammad Rajput Dow University Hospital, Karachi
  • Iftikhar Memon Liaqat university of Medical & Health Sciences Jamshoro
  • Mohsin e Azam Burjeel Hospital-UAE
  • Adeel Ahmed Siddiqui Dow University Hospital, Karachi
  • Jagdesh Kumar Dow University Hospital, Karachi
  • Zulfiqar Ali Liaqat University of Medical & Health Sciences Jamshoro
  • Sadaf Junejo NICH, Karachi
  • Khadijah Abid Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology, Karachi



Primary cemented bipolar hemi arthroplasty (PCBH), unstable intertrochanteric femur fractures (UIF), Harris Hip Score, post-operative complications, elderly patients


Background: To analyse the functional outcome of primary cemented bipolar hemi arthroplasty (PCBH) for unstable osteoporotic intertrochanteric femur fractures in elderly patients. Methods: It was a multicentre prospective study conducted at Institute of Orthopaedics & Surgery, Medicare Cardiac & General Hospital and Dr Ruth K M Pfau Civil Hospital Karachi, Pakistan from February 2015 to July 2020. Thirty-eight patients of 60–90 years of either gender diagnosed as close UIF, severe osteoporosis as per Singh index grade ≤3, time since injury <2 weeks, ASA status II & III and pre-injury independent walking were enrolled in this study. All patients with UIF underwent PCBH. The radiographs were performed before surgery and at intervals postoperatively. All patients were requested to come for follow up visits at 2 weeks, 4 weeks, 3 months, 6 months 1 year and then at 3 years to assess the functional outcome of patients. At first postoperative day check X-rays taken and rehabilitation started as per institutional rehabilitation protocol, at 2-week stiches removed, at 4 weeks’ x-ray was done and all the patients were followed for 3 years. The primary outcomes were noted using Harris Hip Score (HHS) for the functional outcome assessed at the end of 1 year and at final follow up. Results: The mean age of the study participants was 68.29±8.04 years. One male (2.6%) died at 6th month, then 2 females (5.2%) patients died at 1 year and 2 females (5.2%) patients died at the end of 3 years due to multiple comorbid conditions. During 1st year 3 patients (7.4%) developed DVT and 4 patients (10.5%) having diabetes and hypertension developed superficial wound infection. The mean Harris Hip Score between time points which indicated that the mean Harris Hip Score significantly improve over the period of time (p=0.001). Post hoc tests revealed that there were statistically significant differences between each time points (p<0.05). The functional outcome at 3 years, shown, one patient had excellent outcome, 24 patients had good outcome and 8 had fair outcome, respectively. Conclusion: The Primary Cemented Bipolar Hemiarthoplasty is a good choice of treatment in terms of reasonable functional outcome such as early mobilization and associated with less post-operative complications in elderly patients of UIF. 


Lee A, Lee KW, Khang P. Preventing falls in the geriatric population. Perm J 2013;17(4):37–9.

Elhadi AS, Abdelgadir AH, Elbushra EM, Gashi YN. Outcome of primary cemented bipolar hemiarthroplasty in older patients with unstable hip fracture: A prospective study. J Musculoskelet Surg Res 2019;3(2):196–9.

Faizan M, Sabir AB, Asif N, Jilani LZ, Mohan R, Channappanavar C, et al. Functional outcome of cemented bipolar prosthesis in unstable trochanteric fractures in elderly. Egypt Rheumatol Rehabil 2017;44(3):125–9.

Göçer H, Coşkun S, Karaismailoğlu N. Comparison of treatment of unstable intertrochanteric fracture with different arthroplasty methods. Niger Med J 2016;57(2):81–5.

Gashi YN, Elhadi AS, Elbushra IM. Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture. Malays Orthop J 2018;12(1):36–41.

Cha YH, Lee YK, Koo KH, Wi C, Lee KH. Difference in Mortality Rate by Type of Anticoagulant in Elderly Patients with Cardiovascular Disease after Hip Fractures. Clin Orthop Surg 2019;11(1):15–20.

Singh S, Shrivastava C, Kumar S. Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur. J Clin Diagn Res 2014;8(10):LC01–4.

Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017;389(10073):1011–24.

Fan L, Dang X, Wang K. Comparison between bipolar hemiarthroplasty and total hip arthroplasty for unstable intertrochanteric fractures in elderly osteoporotic patients. PLoS One 2012;7(6):e39531.

Yoon BH, Seo JG, Koo KH. Comparison of Postoperative Infection-Related Complications between Cemented and Cementless Hemiarthroplasty in Elderly Patients: A Meta-Analysis. Clin Orthop Surg 2017;9(2):145–52.

Daniel M, Mohammed S, Francis A, William Y, Joseph K, Cornilius E. Early result of hemiarthroplasty in elderly patients with fracture neck of femur. Niger Med J 2015;56(1):64–8.

Sancheti Kh, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop 2010;44(4):428–34.

Sinno K, Sakr M, Girard J, Khatib H. The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients. N Am J Med Sci 2010;2(12):561–8.

Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 2002;26(4):233–7.

Aristote H, Moevi A, Michel L, Madougou S, Zannou R, Padonou J. Treatment of femoral fracture by moore prothesis in Cotonou. Niger J Orthop Trauma 2010;9:5–7.

Essoh JB, Sie MD, Aka D, Kacou MD, Kodo MD, Iambin MD. Austin moore hemiarthroplasty for displaced fracture neck of fractures in patients aged 55years and above. An Ivorian experience. Nigerian J Trauma Orthop 2006;5:18–24.

Stern R. Are there advances in the treatment of extracapsular hip fractures in the elderly? Injury 2007;38(Suppl 3):S77–87.

Stern MB, Angerman A. Comminuted intertrochanteric fractures treated with a Leinbach prosthesis. Clin Orthop Relat Res 1987;218:75–80.

Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty 2005;20(3):337–43.

Ahmad I. Mortality and morbidity in elderly patients with fracture neck of femur treated by hemiarthroplasty. J Coll Physicians Surg Pak 2006;16(10):655–8.

Noor SS, Hussain N, Javed I. Outcome of Austin Moore hemiarthroplasty in elderly patients with fracture neck of femur. J Pak Orthop Assoc 2010; 20:14–9.

D'Arcy J, Devas M. Treatment of fractures of the femoral neck by replacement with the Thompson prosthesis. J Bone Joint Surg Br 1976;58(3):279–86.