Functional Outcome of Hemiarthroplasty of the Hip for Unstable Intertrochanteric Fractures of the Femur in Elderly Patients: A Prospective Study

Abstract

It is frequently challenging to treat an unstable intertrochanteric fracture in elderly people by internal fixation because of difficult anatomical reduction, poor bone quality, the need for prolonged bed rest and restricted ambulation. As an alternative to internal fixation, cemented bipolar hemiarthroplasty has been used as a treatment for unstable intertrochanteric fractures to avoid the postoperative immobilizationrelated complications. The aim of this study was to evaluate the functional and clinical outcomes of primary cemented bipolar hemiarthroplasty for elderly patients with unstable intertrochanteric fractures. MethodologyA prospective study was conducted that included 30 patients who were admitted to the apex trauma center at a tertiary care center from January 2019 to August 2020 with unstable intertrochanteric fractures (Association for Osteosynthesis/Orthopaedic Trauma Association, or AO/OTA, types 31-A2.2 and 31-A2.3); patients treated with cemented bipolar hemiarthroplasty, with at least one year of follow-up were included in the study. Basic descriptive statistics were used and the results were presented in frequencies, percentages for categorical variables and means and standard deviations for continuous variables. ResultsAccording to the Harris Hip Score, at the end of 12 months, 9 patients (30%) had excellent results, 14 patients (46.67%) had good results, 5 patients (16.67) had fair results, and 2 cases (6.67) had poor results. With cemented hemiarthroplasty, 87.7% of older patients with unstable intertrochanteric fractures were able to walk sooner, and the results were good. ConclusionHemiarthroplasty of the hip with a cemented bipolar prosthesis appears to be a reliable treatment method for the management of unstable intertrochanteric fractures in elderly patients with osteoporosis; it allows for early ambulation and leads to a favorable functional outcome in most patients following surgery.

Functional Outcomes of Primary Hemiarthroplasty for Unstable Intertrochanteric Fractures in the Elderly: A Prospective Observational Study

“…Internal fixation, while a common approach, is associated with many complications, including implant cut-out from the femoral head, potentially resulting in profound functional disabilities. These findings emphasize the critical consideration required when choosing the surgical approach for unstable intertrochanteric fractures in the elderly, and the fracture type, bone quality, and potential complications associated with each method should be carefully considered [ 11 ]. Hemiarthroplasty is a frequently utilized alternative that provides stability, enables immediate full weight-bearing, and circumvents many complications associated with internal fixation.…”

Đánh Giá Kết Quả Phẫu Thuật Thay Khớp Háng Bán Phần Điều Trị Gãy Không Vững Liên Mấu Chuyển Xương Đùi Ở Bệnh Nhân Cao Tuổi Tại Bệnh Viện Đa Khoa Cà Mau

“…Gãy không vững liên mấu chuyển xương đùi là loại gãy kiểu A2 và A3 theo phân loại AO, ở bệnh nhân cao tuổi gãy liên mấu chuyển xương đùi có tỷ lệ tử vong cao tới 20% trong năm hậu phẫu đầu tiên. Việc điều trị gãy không vững liên mấu chuyển xương đùi vẫn đang còn gây tranh cãi, mặc dù đã có các báo cáo về các thử nghiệm lâm sàng ngẫu nhiên và nghiên cứu so sánh [3], [4], [5]. Sụp góc cổ thân, lỏng dụng cụ và tụt vít nén ép trượt dẫn đến kết quả chức năng kém là những vấn đề liên quan đến cố định bên trong gãy không vững liên mấu chuyển xương đùi ở bệnh nhân cao tuổi bị loãng xương.…”

Calcar reconstruction in bipolar hemiarthroplasty for unstable intertrochanteric fractures

“…13 A study by CJ Thakkar et al proposed a novel approach utilizing a bone graft fashioned from the femoral head and neck, precisely fitted into the posteromedial void between the bone and stem. 14 This technique not only prevented varus and retroversion of the prosthesis but also facilitated limb length equalization. Building upon this innovative concept, the present study aims to comprehensively evaluate the functional and radiological outcomes of this autologous bone graft calcar reconstruction technique in the context of prosthetic replacement for osteoporotic, severely comminuted intertrochanteric femur fractures.…”