Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

Abstract

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

Biomechanical Effects of the Porous Structure of Gyroid and Voronoi Hip Implants: A Finite Element Analysis Using an Experimentally Validated Model

“…High stress can lead to femoral stem fractures, whereas past research has mentioned that the failure of hip implants is caused by several circumstances, including increasing stress in the stem as a result of patients getting heavier, intense activity, or an undersized hip implant [37,42,43]. According to the FEA results (Figure 7), the topology optimisation approach in designing lightened hip implants revealed that hip implants with a Voronoi structure had the highest strength.…”

Clinical results of intramedullary and hemiarthroplasty in treatment of intertrochanteric fracture with coronal fracture in elderly

“…Inclusion criteria: There were complete imaging data, con rmed as intertrochanteric fracture, and intertrochanteric coronal fracture; Complete follow-up data were available; Physical conditions allow surgical treatment; Age ≥ 60 years Exclusion criteria: femoral neck fracture, subtrochanteric fracture, reverse intertrochanteric fracture; combined with acetabulum and other hip fractures; Serious cardiovascular and cerebrovascular diseases, poor physical conditions, can not tolerate surgery; Systemic or surgical site infection; (5) Patients with severe mental illness who cannot cooperate with treatment; Neoplastic pathological fracture; Incomplete data or loss of follow-up; under 60 years old;…”

“…), extramedullary xation (DHS, external xation stent, etc. ), and there are many reports on related treatment [4][5][6]. However, few studies have reported the clinical effects of intertrochanteric fractures with coronal fractures.…”

Advances in the Restoration and Fixation of Lateral Femoral Wall Fracture

“…However, the treatment of intertrochanteric fracture has seen a shift from non-operative conservative treatment to surgical treatment in view of its high mortality and complications. Surgical intervention has become the preferred treatment for intertrochanteric fractures [4] . In order to obtain better outcomes and prevent internal fixation failures, the research focus has shifted to unstable intertrochanteric fractures.…”

“…In the early days, intertrochanteric fractures were often fixed with extramedullary fixation with a long force arm, which provides support through the posterior medial bone fragment containing the femoral calcar and the lesser trochanter. Therefore, it was believed that the key factor determining the stability of internal fixation was the integrity of the internal structure, especially that of the posterior medial bone fragment, including the lesser trochanter and the femoral calcar [4,5] . With the introduction of internal fixation devices, intramedullary fixation has gradually replaced extramedullary fixation, which was the mainstream treatment for intertrochanteric fractures.…”