Intramedullary Nailing Compared With Primary Total Hip Arthroplasty For Pertrochanteric Fractures In Autonomous Elderly Patients

Description

In this episode of AI Talks with Bone & Joint, the hosts discuss a September 2026 paper by A. Piercecchi and colleagues comparing intramedullary nailing with primary total hip arthroplasty (THA) for pertrochanteric fractures in autonomous elderly patients. The study was a prospective, monocentric randomized controlled trial of patients aged 70 and older who were able to walk outdoors before fracture. Patients were assigned to intramedullary nailing or cementless dual mobility THA with trochanteric fixation, and both groups were allowed immediate full weightbearing after surgery.



The primary outcome was the Harris Hip Score at six months, with secondary measures including the Postel-Merle d'Aubigné score, Parker mobility score, pain, complications, and mortality at six and 12 months. Results showed no significant difference in functional recovery between the two treatments. At six months, the mean Harris Hip Score was 85.7 in the osteosynthesis group and 82.5 in the THA group. Recovery, mobility, and pain remained comparable through 12 months. THA had a significantly longer operating time, while complication rates and one-year mortality were similar between groups.



With extended follow-up over a median of 4.1 years, overall survival also did not differ significantly, and about 80% of patients had died by the end of follow-up. Importantly, no secondary conversions to arthroplasty were needed in the intramedullary nailing group. The hosts conclude that primary THA does not appear justified routinely in this population, and that modern intramedullary nailing remains a reliable treatment option for autonomous elderly patients with pertrochanteric fractures.

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Paper Links

https://boneandjoint.org.uk/Article/10.1302/2633-1462.79.BJO-2026-0142.R1