J Korean Orthop Assoc.  2020 Dec;55(6):503-510. 10.4055/jkoa.2020.55.6.503.

Midterm Results of Bipolar Hemiarthroplasty for Unstable Intertrochanteric Femoral Fractures Using a Type 3C Cementless Stem

Affiliations
  • 1Department of Orthopedic Surgery, St. Carollo Hospital, Suncheon, Korea
  • 2Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
  • 3Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea

Abstract

Purpose
Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery.
Materials and Methods
From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70–84 years), and the mean follow-up period was 85.4 months (range, 60–96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed.
Results
Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures.
Conclusion
Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

Keyword

hip; hip fractures; osteoporosis; hemiarthroplasty
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