***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Total hip arthroplasty is associated with a better long term outcome and lesser reoperation rates in the elderly but the risk of complications are beleived to be higher in very elderly patients . The study aims to compare the short-term results of cemented and cementless total hip arthroplasty ( THA ) in active patients > 80 years of age with femoral neck fractures . Methods Sixty-two consecutive patients underwent THA during the study period  ( cemented—31 and cementless—31 ) . The mean age was 84 years ( 81–94 years ) . Patients in both groups were comparable in their preoperative variables . Functional and radiological assessment s were carried out using vali date d outcome measures . Complications were recorded . Results Fifty-one patients were available for final analysis after accounting for deaths and cases lost in follow-up . Of the 51 patients , 25 ( 49 % ) regained their pre-injury mobility status and 36 ( 70 % ) were community ambulant . Cementless THA was associated with significantly less surgical time , blood loss , transfusion rates and hospital stay . The overall mortality rates , complications , functional and radiological results were similar in both groups though the number of deaths in the perioperative period was significantly high in patients undergoing cemented THA . ConclusionS atisfactory improvement in function with low reoperation rates can be achieved irrespective of the technique used . Complication rates are higher when compared to younger patients undergoing the procedure . Risks and benefits should be carefully assessed and explained before subjecting these patients to THA BACKGROUND More than 220,000 persons 65 years and older fracture a hip every year in the United States . Although hip fractures have been considered as a single , homogeneous condition , there are two major anatomic types of proximal femoral fractures : intertrochanteric and femoral neck . The present study 's objective was to determine if the two types of hip fracture have different patient characteristics and sequelae . METHODS A prospect i ve study of 923 elderly patients admitted to seven Baltimore hospitals for a hip fracture between 1984 and 1986 . RESULTS Patients with intertrochanteric fractures  were slightly older , sicker on hospital admission , had longer hospital stays , and were less likely at 2 months postfracture to have recovered activities of daily living than femoral neck fracture patients . Intertrochanteric fracture patients also had higher mortality rates at 2 and 6 months after fracturing . Long-term recovery ( 1 year ) did not differ between fracture type . CONCLUSIONS It appears that intertrochanteric fracture patients have intrinsic factors ( older age , poor health ) impacting upon their risk of fracture and ability to recover . Differences in patient characteristics and sequelae do exist between femoral neck and intertrochanteric hip fracture patients that impact upon recovery Background Displaced femoral neck fractures usually are treated with hemiarthroplasty . However , the degree to which the design of the implant used ( cemented or uncemented ) affects the outcome is not known and may be therapeutically important . Questions / purpose sIn this r and omized controlled trial , we sought to compare cemented with cementless fixation in bipolar hemiarthroplasties at 5 years in terms of ( 1 ) Harris hip scores ; ( 2 ) femoral fractures ; ( 3 ) overall health outcomes using the Barthel Index and EQ-5D scores ; and ( 4 ) complications , reoperations , and mortality since our earlier report on this cohort at 1-year followup . Methods We present followup at a median of 5 years after surgery ( range , 56–65 months ) from a r and omized trial comparing a cemented hemiarthroplasty ( 112 hips ) with an uncemented , hydroxyapatite-coated hemiarthroplasty ( 108 hips ) , both with a bipolar head . Results were previously reported at 1-year followup . Harris hip scores , Barthel Index , and EQ-5D scores were assessed by one research nurse and one orthopaedic surgeon . Complications and reoperations were determined by chart review and radiographs examined by three orthopaedic surgeons . Sixty patients ( 56 % ) had died in the cemented group and 63 ( 60 % ) in the uncemented group . Respectively , three and two patients ( 2.7 % and 1.9 % ) were completely lost to followup . Results Harris hip scores at 5 years were higher in the uncemented group than in the cemented group ( 86.2 versus 76.3 ; mean difference 9.9 ; 95 % confidence interval [ CI ] , 1.9–17.9 ) . The prevalence of postoperative periprosthetic femoral fractures was 7.4 % in the uncemented group and 0.9 % in the cemented group ( hazard ratio [ HR ] , 9.3 ; 95 % CI , 1.16–74.5 ) . Barthel Index and EQ-5D scores were not different between the groups . Between 1 and 5 years , we found no additional infections or dislocations . The mortality rate was not different between the groups ( HR , 1.2 ; 95 % CI , 0.82–1.7 ) . Conclusions Both arthroplasties may be used with good medium-term results after displaced femoral neck fractures . The uncemented hemiarthroplasty may result in higher hip scores but appears to carry an unacceptably high risk of later femoral fractures . Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Background The treatment of unstable intertrochanteric fractures in elderly is still controversial . The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using st and ard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment . Methods Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospect i ve cohort study . All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems . Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system . Follow-up evaluations were performed at least 24 months and later . Palmer and Parker mobility score and visual analogue scale ( VAS ) pain score were assessed . We also analyzed radiographs of the operated hip at each follow-up visit . Results The patients were 15 males and 39 females with a mean age of 81.3 years ( range , 75 to 93 years ) . The average operative time was 86.6 minutes . The mean transfused blood units were 1.2 units . The average duration of hospital stay was 5.3 days . The preoperative mean mobility score was 6.20 . This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively . The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days . Radiological interpretation revealed no loosening in the cable-grip systems , and no significant subsidence ( > 5 mm ) of prosthesis was observed . Conclusions Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis , frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures INTRODUCTION Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat . Conservative treatment with traction and prolonged immobilization l and s up with many complications and often fatality . Rate of failure with internal fixation , with dynamic hip screws has been found to be high , especially in osteoporotic bones .  Revision osteo synthesis is technically dem and ing and it leads to complications . The aim of this study was to assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis . MATERIAL AND METHODS Twenty patients ( 11 males and 9 females- all were 65 years old or above ) who underwent bipolar arthroplasty for unstable intertrochanteric fractures were prospect ively evaluated .  Moore 's approach was used in all patients . Greater Trochanter encirclage was done in 10 ( 50 % ) patients . Harris hip score was used for the clinical evaluation . The mean follow up period was 9 months . RESULTS In our study which was done on 20 cases which had a mean age 72.4 years , 14 cases were of type 2 fractures , 3 were of type 3 , 2 were of type 1 fractures and 1 was of type 4 . The average Harris hip score was 75 . Excellent to fair results were obtained at follow-up in 18 ( 90 % ) cases and in 2 ( 10 % ) cases , the results were poor . Average hospital stay was 13.3 days . There was one case of a superficial operative site infection and one case of a deep infection . There was no case with loosening of the prosthesis , break in the cement or sinking of the prosthesis . CONCLUSION The treatment of unstable intertrochanteric fractures in elderly patients with severe osteoporosis differs from the treatment of patients with other proximal femoral fractures . These fractures are better treated with cemented hemi-arthroplasty than with internal fixation . Besides an early ambulation and less hospital stay , cemented hemi-arthroplasty provides stable and mobile hips . Weight bearing can be started earlier than in other methods of treatment , which prevents any recumbency related complications INTRODUCTION Fractures of the Intertrochanteric ( IT ) region are some of the most common fractures encountered by an orthopedic surgeon in his lifetime . With increase in life expectancy , the incidence of these fractures is also increasing . By 2040 , the incidence of these fractures is expected to double . Unstable IT fractures are a major cause of concern in the elderly due to the associated increase in morbidity and mortality . AIM The purpose of this study was to compare the intraoperative and postoperative parameters using the Dynamic Hip Screw ( DHS ) , the Cemented Bipolar Hemiarthroplasty ( BH ) and the Proximal Femoral Nail ( PFN ) for the management of unstable IT fractures . MATERIAL S AND METHODS Fifty patients , having unstable IT fractures with age more than 60 years were r and omly selected and were followed up averagely for 19 months ( 12- 30 months ) . The type of implant for a particular patient and a particular type of fracture was r and omly selected and the same surgical team treated all patients . Total number of 19 patients were operated using the DHS ( Group-1 ) , 13 using the BH ( Group-2 ) and 18 using the PFN ( Group-3 ) . All patients in the three groups were compared in terms of preoperative , intraoperative and postoperative parameters and functionally assessed using the Harris hip score and the mobility score of Parker and Palmer . RESULTS Patients operated using the PFN had significantly lower mean blood loss as compared to the other two groups . The mean days to unaided Full Weight Bearing ( FWB ) was significantly higher in patients treated by the DHS as compared to the other two groups . All three groups were comparable in terms of functional assessment . CONCLUSION Treatment of unstable IT fracture of femur is a matter open to debate . IT fractures of elderly must be treated with considering the age of the patient , mental status , bone quality , and the type of fracture . Level of Evidence according to OCEBM Levels of Evidence Working Group - Level 2 The potential safety and effectiveness of a practice guideline recommending a 5-day postoperative stay in the acute care hospital for hip surgery patients without clinical findings predictive of a complicated hospital course was studied retrospectively in 230 patients hospitalized for total hip replacement , total hip replacement with osteotomy , or hip hemiarthroplasty .  Seventy percent of total hip replacement and hip hemiarthroplasty patients were classified as being at " low risk " for complications by the guideline ( 161 patients , or 73 % of patients who remained hospitalized ) . Use of the guideline could have reduced the hospital length of stay from 8.4 days ( st and ard deviation 3.3 ) to 5.9 days for these selected low-risk patients . Moreover , physicians ' implicit review determined that 0 % of patients ( 95 % confidence interval , 0 % to 2.3 % ) had a complication that would have benefited from continued stay in an acute care hospital after the fifth postoperative day . Our practice guideline may have the potential to safely reduce acute care hospital length of stay for patients recovering after total hip replacement and hip hemiarthroplasty . The guideline will require further study in a prospect i ve clinical trial before it can be recommended for widespread use Background : The management of unstable osteoporotic intertrochantric fractures in elderly is challenging because of difficult anatomical reduction , poor bone quality , and sometimes a need to protect the fracture from stresses of weight bearing . Internal fixation in these cases usually involves prolonged bed rest or limited ambulation , to prevent implant failure secondary to osteoporosis . This might result in higher chances of complications like pulmonary embolism , deep vein thrombosis , pneumonia , and decubitus ulcer . The purpose of this study is to analyze the role of primary hemiarthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures . Material s and Methods : We retrospectively analyzed 37 cases of primary hemiarthroplasty performed for osteoporotic unstable intertrochanteric 
    Output:
    
Conclusion Cemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates ; however , the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group