Comparison of Outcomes Following Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures versus Unstable Intertrochanteric Fractures: A Retrospective Propensity-Matched Study.

Background: Bipolar hemiarthroplasty (BHA) is commonly used for displaced femoral neck fractures but less frequently for unstable intertrochanteric fractures. This study aimed to compare outcomes of BHA in these two fracture types among elderly patients. Methods: We retrospectively reviewed 319 femoral neck and 40 intertrochanteric fracture patients treated with BHA. After 1:4 propensity score matching, 38 intertrochanteric patients were compared with 152 femoral neck patients. Primary outcomes included operative time, blood loss, transfusion needs, hospital stay, and complications. Results: The intertrochanteric group had significantly longer median operation time (195 vs. 170 minutes, p = 0.008), greater blood loss (300 vs. 200 mL, p < 0.001), and higher transfusion requirements postoperatively (2.4 vs. 0.7 units, p < 0.001). Hospital stay was longer (11.5 vs. 9 days, p < 0.001). Medical complications, particularly cardiovascular events (13.2% vs. 1.3%), were more common in the intertrochanteric group (p= 0.007). Surgical complication rates were similar between groups (p = 0.78). Conclusions: BHA for unstable intertrochanteric fractures is associated with greater surgical burden and a higher risk of medical complications compared with its use for displaced femoral neck fractures. However, the similar rates of surgical complications observed suggest that bipolar hemiarthroplasty may be considered in carefully selected high-risk elderly patients when stable internal fixation is not feasible.