To observe and investigate the application of prostheses consisting of titanium alloy long stem and bipolar femoral head with different coatings in hip hemiarthroplasty (HHA) for treatment of geriatric femoral unstable intertrochanteric fractures.

From January 2018 to December 2021, 110 senile patients underwent HHAs for femoral unstable intertrochanteric fractures (59 patients had severe osteoporosis with T value under 2.5) in XD Group Hospital. A retrospective analysis was performed on the perioperative and follow-up informations of these patients. The femoral stems for implantation were titanium alloy stems, and 64 and 46 HHAs used stems coated with hydroxyapatite and with micro-arc oxidized TiO₂, respectively. The overall comorbidities during hospitalization and changes in Harris hip scores (HHS) were compared at three, six, 12, 24 months after surgery by t test and variance analysis. Radiographic features were recorded and analyzed, including osteolysis, prosthesis subsidence, acetabular erosion, cortical porosis, heterotopic ossification, and leg length discrepancy, as well as records of stem revisions.

All the patients were followed up for 44 (35, 55) months, and among them 89 patients had postoperative radiographs available for analysis. HHS scores after operation showed no statistically significant differences in inter-group effect (F=0.634, P>0.05, ∂η²=0.006) or interactive effect (F=0.338, P>0.05, ∂η²=0.003), while the difference in time effect was statistically significant (F=656.51, P<0.001, ∂η²=0.859). There was observed a relatively low occurrence of negative features according to radiographic analysis. No prosthesis loosening, osteolysis, or leg length discrepancy was found. One case encountered prosthesis subsidence (1.1%), two (2.3%), one (1.1%), and three (3.4%) hips encountered acetabular erosion, heterotopic ossification, and cortical porosis respectively; three hips (3.4%) received stem revision owing to periprosthetic fractures.

The application of titanium alloy femoral long stems can achieve satisfactory utility in HHA treatment of geriatric femoral unstable intertrochanteric fractures. Due to the merits such as shorter surgery time compared to cemented-type stems, titanium alloy femoral stems have more promising applicative potential.