Bekir Karagöz, Mustafa Erdem, Ali Geçer, Hünkar Çağdaş Bayrak, Alican Barış, İsmail Ağır
İstanbul Medical Journal - 2026;27(2):122-128
Introduction: This study aims to compare the clinical and radiographic outcomes of cementless calcar replacement stems (CRSs) and distally fixed modular stems (DFMSs) in elderly patients undergoing hemiarthroplasty for unstable intertrochanteric femur fractures. Methods: A retrospective cohort study was conducted on 138 patients who underwent cementless hip hemiarthroplasty for unstable intertrochanteric fractures at two tertiary university hospitals between 2017 and 2023. Patients aged 65 years or older with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association type A2.2, A2.3, or A3 fractures were included. Based on the type of implant, patients were divided into two groups: CRS (n=67) and DFMS (n=71). The groups were compared in terms of demographic data, operative time, intraoperative blood loss, transfusion requirements, complications, Harris Hip Score (HHS), and Parker Mobility Score (PMS). Minimal Clinically Important Difference (MCID) analyses were performed for functional outcomes. Results: Hospital stay, operative time, intraoperative bleeding, and transfusion needs were significantly lower in the DFMS group than in the CRS group (p=0.002; p=0.004; p=0.024; p=0.003, respectively). The incidence of dislocation was higher in the CRS group (p=0.039), while no significant differences were observed in other complications. HHS and PMS scores at 6 and 12 months postoperatively did not differ significantly between groups, and none of the differences exceeded the MCID thresholds. Conclusion: Although functional outcomes were comparable between the two stem types, DFMSs demonstrated statistically significant advantages in terms of surgical duration, blood loss, transfusion requirements, and complication rates.
