Comparative Analysis of the Effects of Hemiarthroplasty and Proximal Femoral Nail on Mortality in Hip Fractures

Abstract

This retrospective study aimed to compare the effects of hemiarthroplasty and proximal femoral nail on one-year mortality in patients over 65 years of age with femoral intertrochanteric fractures. A total of 307 patients treated for femoral intertrochanteric fracture between January 1, 2019, and December 31, 2021, were evaluated and divided into two groups: hemiarthroplasty (Group 1) and proximal femoral nail (Group 2). Data collected included demographic information, pre- and postoperative hemoglobin and albumin levels, neutrophil-to-lymphocyte ratios, presence of osteoporosis, duration of surgery, length of hospital stay, postoperative intensive care unit requirement, presence of additional trauma, American Society of Anesthesiologists scores, cardiac ejection fraction values, and comorbidities assessed using the Modified Charlson Comorbidity Index. Receiver operating characteristic analysis was used to determine cut-off values for factors significantly affecting mortality. The mean age of the patients was 81.38 ± 8.014 years, with a mean follow-up of 14.48 ± 9.69 months (range = 1–36). The overall one-year mortality rate was 39.1% (n = 120): 41.9% in Group 1 and 32.6% in Group 2. Univariate regression analysis showed that age, sex, American Society of Anesthesiologists scores, ejection fraction, pre- and postoperative albumin levels, Modified Charlson Comorbidity Index, and intensive care unit stay duration significantly affected mortality. Multiple logistic regression identified male sex as a risk factor in Group 1 and intensive care unit admission in Group 2. This study demonstrates that, irrespective of the implant type, patients' existing chronic illnesses and metabolic conditions must be carefully assessed.