Hip arthroplasty for intertrochanteric fractures in elderly patients: primary acute surgery provides better outcomes compared to treatment after fixation failure

Introduction. Intertrochanteric fractures in elderly patients are often treated with internal fixation, but failure rates of 3–12% necessitate revision surgery. Hip arthroplasty (HA) is an alternative that allows early mobilization and reduces immobility-related complications. However, delayed HA after fixation failure presents technical challenges and increased morbidity. This study compares outcomes between acute and delayed HA to determine the optimal treatment strategy. Methods. This retrospective cohort study analyzed patients over 75 years old with AO/OTA 31-A1 and 31-A2 fractures who had at least one year of follow-up. Patients were divided into two groups: those who underwent acute hip arthroplasty (HA), including total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA), and those who initially underwent internal fixation, which later failed and required delayed HA. Clinical and surgical outcomes were compared. Results. A total of 111 patients were included (Group A: 74 acute HA; Group B: 37 delayed HA after fixation failure). Patients treated acutely with HA had significantly shorter surgical times (70.2 ± 13.1 min vs. 149.2 ± 62.9 min; p < 0.001), higher hemoglobin levels at discharge (9.7 ± 2.4 g/dL vs. 9.1 ± 1.8 g/dL; p = 0.023), and shorter hospital stays (5.4 ± 3.1 days vs. 10.1 ± 11.9 days; p < 0.001). Complications were more frequent in patients undergoing delayed HA, with a higher rate of hospital readmissions for orthopedic complications (18.9% vs. 2.7%; p = 0.006), periprosthetic joint infections (10.8% vs. 1.4%; p = 0.042), and reoperations (16.2% vs. 2.7%; p = 0.016). The 1-year survival rate was significantly higher in Group A (74.3%) compared to Group B (45.9%) (p = 0.006). Conclusions. Acute HA as a primary treatment for intertrochanteric fractures in elderly patients leads to better short-term outcomes compared to HA performed after fixation failure. Treatment strategies for intertrochanteric fractures in elderly patients should be carefully assessed.