Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture

Abstract

Purpose: Treatment for an unstable intertrochanteric fracture in elderly patients is challenging. Bipolar hemiarthroplasty (HA) using microarc oxidation (MAO) coating has been a treatment option alternative to internal fixation. However, the outcome of bipolar HA using MAO-coated stem in these patients is unknown. Methods: From July 2007 to April 2016, 234 (older than 65 years) patients (234 hips) who were diagnosed as having unstable intertrochanteric fractures were treated with bipolar HA using a fully MAO-coated standard-length rectangular cementless stem. During the arthroplasty, the greater trochanteric and the medial fracture fragments were attached to the stem and fixed with two to three 16-gauge wires. Forty-eight patients (48 hips) died within postoperative 2 years. The remaining 186 patients (186 hips) were followed up for a mean of 4.3 (range 2–10) years. Results: With the exception of 4 patients who died during hospitalization, 176 of 230 ( 76.5%) patients could ambulate independently with or without an assistive device at the time of hospital discharge. Venous thromboembolism occurred in seven patients (3.0%). One hip dislocated due to a fall 1 month after the arthroplasty. Periprosthetic femoral fracture occurred in four patients and periprosthetic acetabular fracture in one patient. One patient had periprosthetic of acute pyelonephritis. There was no focal osteolysis around the femoral stem. Conclusion: The result of cementless HA using MAO-coated stem enabled early ambulation in most (76.5%) of elderly patients with unstable intertrochanteric fractures and the results were encouraging.

Midterm outcome analysis of bipolar hemiarthroplasty for unstable intertrochanteric femur fractures: A retrospective study

“…Recently, the cementless stem has been widely used for hip arthroplasty and there have been many studies reporting good results for unstable intertrochanteric fractures [3][4][5][6][7][8][9]. However, studies evaluating the long-term outcomes patients who have survived for over five years or femoral stems applied using different fixation methods according to each design have been small studies.…”

“…Specifically, if the type 3C stem is used for intertrochanteric fractures in which the proximal region is fractured, the bone ongrowth of the proximal region may be poorer because the fixation force is mainly obtained in the diaphysis and stable three-point fixation cannot be achieved. Some studies have reported good results with type 3C stems for unstable intertrochanteric fractures [3,7]. However, studies that report excellent results using these type 3C stems have been mostly short-term.…”

“…Furthermore, the use of cementless femoral stems is increasing and various designs and surface coated methods have been used for unstable intertrochanteric fractures with good results [3][4][5][6][7][8][9].…”

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

“…The surgical approach to CFFs has gained clarity in the literature [12], while surgical indication in ITFs is still controversial [13]. While many surgeons always prefer osteosynthesis in ITF, many surgical teams prefer hemiarthroplasty [14].…”

Hip arthroplasty for unstable femoral trochanteric fractures using the direct anterior approach

“…On the other hand, the hip arthroplasty for this fracture may lead to a stable outcome regarding functional recovery and pain relief by devising a speci c surgical procedure [5,6]. However, the hip arthroplasty was applied through the posterior approach in many reports, for which large surgical stress is of concern, the risk of dislocation is high, and osteosynthesis is additionally applied to the greater trochanter [7][8][9]. Recently, the direct anterior approach (DAA) for applying the hip arthroplasty has been attracting attention as an approach capable of conservation of soft tissue, which enables early functional recovery and a low dislocation rate [10][11][12].…”