Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series

Abstract

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.Materials and Methods:We retrospectively analyzed 37 cases of primary hemiarthroplasty performed for osteoporotic unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV fractures). There were 27 females and 10 males with a mean age of 77.1 years (range, 62–89 years).Results:Two patients died due to unrelated cause (myocardial infarction) within 6 months of surgery and remaining 35 patients were followed up to an average of 24.5 months (range,18–39 months). The average surgery time was 71 min (range, 55–88 min) with an average intraoperative blood loss of 350 ml (range, 175–500 ml). Six patients needed blood transfusion postoperatively. The patients walked on an average 3.2 days after surgery (range, 2–8 days). One patient had superficial skin infection and one had bed sore with no other significant postoperative complications. One patient of Alzheimer’s disease refused to walk and had a poor result. A total of 32 out of 35 patients (91%) had excellent to fair functional results and 2 had poor result with respect to the Harris hip score (mean 84.8±9.72, range 58-97). One patient who had neurological comorbidity refused to walk post operatively and was labeled as failed result.Conclusion:Hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in elderly results in early ambulation and good functional results although further prospective randomized trials are required before reaching to conclusion.

Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: Case report

“…Some studies reported that hip arthroplasty in treating these fractures had more advantages than internal fixations [4], [16], [17], [18], [19]. However, the findings of the present study did not support hemiarthroplasty as a preferred choice when compared with PFNA.…”

Primary hemiarthroplasty for treatment of unstable pertrochanteric femoral fractures (AO/OTA Type 31 A2.3) in elderly osteoporotic patients

“…However, the indications for such a procedure are not yet well defined: one major indication might be a comminuted and unstable pertrochanteric fracture in an elderly and debilitated patient with osteopenic or osteoporotic bone [2, 3, 5, 17, 18]. …”

“…Other studies have also shown a higher rate of complications in patients treated with osteosynthesis when compared to arthroplasty, leading to more application of arthroplasty techniques [5]. …”

“…Optimal treatment and management of these unstable pertrochanteric femoral fractures in elderly osteoporotic patients remains a challenge in current orthopedic trauma practice. Internal fixation may be associated with nonanatomic reduction of fracture fragments, long bed rest periods, prolonged protected weight-bearing, bone fragment necrosis, and secondary loss of reduction due to unstable fixation in poor quality bone [5–8]. Moreover, these fractures are associated with substantial morbidity and mortality; about 30% of elderly patients die within one year of fracture [2, 9].…”

Primary Cemented Bipolar Hemiarthroplasty With Trochanteric and Calcar Reconstruction in Unstable Intertrochanteric Fractures in Elderly: A Prospective Study

“…KH Sancheti et al 16 retrospectively analyzed 37 cases of primary hemiarthroplasty done for elderly, osteoporotic, unstable IT fractures and 91% had excellent to fair functional results.…”