A Fragile Balance: Survival Analysis Following Bipolar Hemiarthroplasty in the Elderly

Hip fractures in the elderly are a significant cause of morbidity and mortality, with 1-month and 1-year mortality rates reaching up to 10% and 20%, respectively. While non-modifiable risk factors such as age and comorbidities are well-documented, modifiable factors such as surgical delay and rehabilitation remain underexplored in the Indian context. This study aimed to evaluate postoperative mortality and survival outcomes in elderly patients undergoing bipolar hemiarthroplasty and identify key predictors of mortality.

A retrospective cohort study was conducted on patients aged ≥ 70 years who underwent bipolar hemiarthroplasty for proximal femoral fractures at a tertiary institute from January 2021 to July 2024. Data were collected from hospital records and follow-up was conducted telephonically. Patients with incomplete records or who were unavailable for follow-up were excluded. Survival was assessed using Kaplan-Meier analysis, and predictors were evaluated using log-rank tests and Cox proportional hazards modeling.

Sixty-two patients (30 males, 32 females) were included; 46 were aged ≥ 75 years. Cemented implants were used in 30 and uncemented in 32 patients. Comorbidities were present in 19 patients. Seventeen patients (27.4%) died during follow-up: 8 within 1 month, 7 within 6 months, and 2 within 2 years postoperatively. The mean time to mobilization was 3.27 days. Increasing age was a significant predictor of mortality (HR 1.08; 95% CI 1.01-1.17; p = 0.035), as were comorbidities (p = 0.014). Gender, implant type, anesthesia, and hospital stay duration were not significantly associated with mortality.

Advanced age and the presence of comorbidities significantly increase the risk of mortality following bipolar hemiarthroplasty in elderly patients. Early postoperative deaths highlight the need for timely surgery and robust perioperative care. Improving systemic optimisation may offer the best chance at enhancing survival in this high-risk population.