Calcar reconstruction in bipolar hemiarthroplasty for unstable intertrochanteric fractures

Abstract

: The increasing popularity of primary bipolar hemiarthroplasty for comminuted and osteoporotic intertrochanteric femur fractures is well-documented. However, the absence of posteromedial calcar support due to fracture presents a unique challenge: implant instability and varus collapse. Existing solutions, relying on stem modifications or bone cement void filling, encounter limitations in cost-effectiveness and biomechanical performance.: This study evaluated the efficacy of posteromedial calcar reconstruction using autologous cortical grafts harvested from the extracted femoral head and neck in 30 patients with intertrochanteric femur fractures. Following strict inclusion and exclusion criteria, primary bipolar hemiarthroplasty was performed with meticulous graft implantation. Weight-bearing and range-of-motion exercises commenced on postoperative day 1. Functional and radiological outcomes were assessed at 12 months follow-up. The demographic distribution revealed a 50:50 split between patients above and below 75 years old. 73.33% (n=22) fractures were right-sided, and AO 31-A2.2 emerged as the most prevalent fracture pattern (46.67%, n=14). An acceptable functional and radiological outcome was achieved in 93.33% (n=28) patients. Two complications (superficial infection and implant breakage) resulted in unacceptable outcomes. Notably, the calcar grafts demonstrated robust healing in patients with favorable functional outcomes (Excellent and Good), as evidenced by a mean Harris Hip Score of 93.11 at 1 year follow-up. This study demonstrates the potential of a well-shaped, wedged autologous cortical graft harvested from the femoral head and neck as an effective strategy for calcar reconstruction in intertrochanteric femur fractures. This technique facilitates graft union, prevents implant subsidence, and offers enhanced biomechanical stability with optimal stress distribution. Furthermore, it eliminates the need for allograft or donor site morbidity, leading to reduced costs and patient burden.