Purpose: This study evaluated the rate of mortality and analyzed the associated risk factors in elderly patients treated with bipolar hemiarthroplaty for the hip fractures.
Materials and Methods: Between March 1994 and March 2010, the clinical records of 246 patients(278 cases) older than 75 years of age who underwent bipolar hemiarthroplaty after hip fractures were reviewed. The mean age of the subjects was 83.7 years(75-103 years). The relationship between the postoperative one year mortality and the related factors (age, gender, type of hip fractures, the timing of surgery, the associated medical condition, ASA grade, osteoporosis, walking ability and residence type) were analyzed. The subjects were divided into the dead group and survivor group.
Results: The mean postoperative mortality rate within 1 year was 17.2%(48 cases). The highest mortality rate was observed at postoperative 3 months(9.7%, 27 cases), followed in order by between 4 and 6 months(5.4%, 15 cases) and 7 and 12 months(2.1%, 6 cases). The postoperative mortality rate within 1 year was affected by the timing of the operation, ASA grade, patient’s walking ability, and residence type, but there were no significant difference of the other factors, such as age, gender, osteoporosis, and type of hip fractures.
Conclusion: The ASA grade, timing of the operation, walking ability, and residence type are factors associated with the mortality rate in elderly patients with hip fractures.

Purpose: The purposes of the current study were to assess the early results of cementless hip arthroplasty (HA) for femoral neck fractures in elderly patients with severe osteoporosis and to compare the clinical outcomes between those who underwent total HA (THA) or bipolar hemiarthroplasty (BHA).
Materials and Methods: From April 2011 to May 2012, we performed 87 cementless HAs for displaced femoral neck fractures in elderly patients (≥65 years) with severe osteoporosis. Among them, we studied 70 hips that were able to be followed-up for >24 months. Of these, 34 underwent THA and 36 underwent BHA. Clinical results were evaluated using the Harris hip score (HHS), Koval classification, and radiographs.
Results: Only one instance of femoral stem loosening was observed. Additionally, no dislocations were observed and no revision surgeries were required. The mean changes in the functional items of the HHS scores were 2.8 and 5.2 for those who underwent THA and BHA, respectively (P<0.05). According to the Koval classification used for the ambulatory status analysis, the mean perioperative change in the grade was 0.8 (0-4), with no significant differences noted between the THA and BHA groups.
Conclusion: The early results of cementless HA for femur neck fractures in elderly patients with osteoporosis were satisfactory, and THA was found to have a functional advantage over BHA.

Purpose: To evaluate outcomes after treatment of femoral neck fractures in patients 75 years of age or older.
Materials and Methods: We reviewed the records of 186 patients 75 years of age or older who underwent bipolar hemiarthroplasty between March 1995 and March 2005 and who were followed for more than two years after surgery. The mean patient age was 84.3 years (range 75~99 years). Forty-eight patients were men, and 138 patients were women. The mean follow-up period was 68.4 months (range 24~113 months). We evaluated the results by analyzing modified Harris hip score, walking ability, activities of daily living, complications, osteoporosis, and radiologic findings.
Results: The mean Harris hip score was 89.2 (range 74~95). Walking ability was recovered in 87.6% of cases (163 cases), and activities of daily living were achieved in 85.4% of cases (159 cases). There were 3 cases of acetabular erosion or proximal migration and 3 cases of aseptic loosening in a cemented stem. Thigh pain occurred in 8 cemented stems and in 4 cementless stems.
Conclusion: We believe bipolar hemiarthroplasty is a useful treatment in elderly patients with femoral neck fractures and severe osteoporosis, especially in view of the stable and rigid fixation of the femoral stem, early ambulation, and the low rate of complications and death, even if the operation is technically very difficult.

Purpose: We conducted a retrospective case-control study to evaluate the factors predictive of hip fractures in elderly patients.
Materials and Methods: We studied 172 patients age 70 years or older who sustained hip fractures with minor injuries between January 2002 and January 2007. We analyzed bone mineral density, comorbidities, body mass index, and the activities of daily living (ADL) scale. One hundred eighty patients (control subjects) with no history of fracture were matched to the study subjects with respect to age and sex.
Results: Multivariate logistic regression showed that female sex, low bone mineral density, high ADL scale, cerebral vascular attack, and knee osteoarthritis were associated with an increased incidence of hip fracture.
Conclusion: Female sex, low bone mineral density, and high ADL scale were related to hip fractures in the elderly. Knee osteoarthritis should be regarded as an independent risk factor for fractures because of an increased risk of falling.

Purpose: The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients.
Materials and Methods: A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined.
Results: Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group (P<0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (P=0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14±138.51 mL in the DAA group (P<0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45 ±4.18 days in the DAA group (P=0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group.
Conclusion: Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.

Purpose: Nondisplaced femoral neck fractures have traditionally been treated with in situ fixation. However, poor surgical and clinical outcomes have been reported for fractures with valgus deformity >15°, and the reduction of valgus impaction has recently been emphasized. In addition, early degenerative osteoarthritis can be caused by cam-type femoroacetabular impingement after healing of femoral neck fractures. This study was designed with the objective of confirming the difference in progression of radiographic osteoarthritis according to the severity of the valgus deformity.
Materials and Methods: Patients who underwent internal fixation using multiple cannulateld screws for management of nondisplaced femoral neck fractures were divided into two groups: high valgus group (postoperative valgus angle ≥15°) and low valgus group (postoperative valgus angle <15°). Evaluation of demographic data and changes in the joint space width from the immediate postoperative period to the latest follow-up was performed.
Results: A significant decrease in joint space width in both hip joints was observed in the high valgus group when compared with the low valgus group, including cases with an initial valgus angle less than 15°and those corrected to less than 15°of valgus by reduction. No complications requiring surgical treatment were observed in either group; however, two cases of avascular necrosis, one in each group, which developed in the low valgus group after reduction of the fracture, were followed for observation.
Conclusion: Performing in situ fixation in cases involving a valgus deformity ≥15°in non-displaced femoral neck fractures may cause accelerated narrowing of the hip joint space.