Hip Pelvis.  2014 Sep;26(3):157-165. 10.5371/hp.2014.26.3.157.

Primary Cementless Hip Arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys: Short-term Results

• Cho SH
• Cho HL
• Cho H

• KMID: 2054179
• DOI: http://doi.org/10.5371/hp.2014.26.3.157

Abstract

PURPOSE
This study was aimed to explore and report the short term results of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderlys.
MATERIALS AND METHODS
Between March 2009 and Feburary 2012, 35 arthroplasty cases performed by single surgeon and followed up for more than one year were evaluated. They were 21 females and 14 males with mean age of 78 years (range, 71-92 years). Preoperative evaluation was performed by American Society of Anesthesia score. Retrospective evaluation was performed by operative time, transfusion amount, time to operation days, hospital stay and time to full weight bearing. Clinically, ambulatory ability was checked by Parker and Palmer (P&P) score and function of hip was appraised by Harris hip score (HSS). Radiologically, bone healing of fractured trochanteric fragment and presence of subsidence, stress shielding or osteolysis were checked.
RESULTS
Fracture type was 11 cases of A2.2, 18 cases of A2.3 and 6 cases of A3.3. Femoral stems used were 8 cases of rectangular tapered wedge type and 27 cases of fluted modular distal fixation type. P&P score improved from mean preinjury score of 7.1 to mean postoperative last follow-up score of 6.5. Median HHS at last follow-up was 75. Mean time to full weight bearing was 47 days (24-79 days). Postoperative complications were one case of linear periprosthetic femoral fracture and one case of postoperative dislocation.
CONCLUSION
Cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderlys.

Keyword

Hip; Intertrochanteric femur fracutre; Hip replacement arthroplasty

MeSH Terms

Anesthesia
Arthroplasty*
Arthroplasty, Replacement, Hip
Dislocations
Female
Femoral Fractures
Femur*
Follow-Up Studies
Hip*
Humans
Length of Stay
Male
Operative Time
Osteolysis
Postoperative Complications
Retrospective Studies
Weight-Bearing

Figure

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  Fig. 1 (A) Meta-diaphyseal fixating monoblock rectangular stem (Lima-Lto, Udine, Italy). (B) Diaphyseal fixating modular fluted long stem (Lima-Lto).

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  Fig. 2 (A) Intraoperative view of a case where primary stability was achieved with monoblock rectangular stem. Reconstruction of femoral calcar was able to be performed with autogenous femoal head or neck fragment to prevent hoop stress and add stability to stem. (B) In case where primary stability was not able to be obtained because of quality of bone or broken intramedullary calcar, modular Wagner type femoral stem was chosen. Distal fixing component was shown.

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  Fig. 3 Seventy-year-old man with unstable intertrochanteric fracture with communited femoral neck fracture who was treated with total hip arthroplasty. (A) Preoperative computed tomography, (B) preoperative X-ray, (C) postoperative X-ray, (D) postoperative X-ray in 9 months.

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  Fig. 4 Seventy-year-old woman with unstable intertrochanteric fracture treated with total hip arthroplasty. (A) Preoperative computed tomography, (B) preoperative X-ray, (C) postoperative X-ray, (D) postoperative X-ray in 13 months.

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  Fig. 5 Acetabular erosion developing to posterosuperior acetabular defect. (A) Preoperative X-ray. (B) Postoperative X-ray; preserved joint space. (C) Postoperative X-ray in 6 months; superolateral acetabular erosion. (D) Postoperative X-ray in one year; posterosuperior acetabular defect.

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