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Abstract
Purpose
To evaluate the positive effects and problems through clinical and radiological results of cementless bipolar hemiarthroplasty for intertrochanteric fractures above type A2 in the elderly.
Materials and Methods
From December 2006 to June 2009, 54 bipolar hemiarthroplasties were performed in 54 patients in our hospital. The mean age was 78.8 (67-93) years. Of these cases, 13 were male and 41 were female. The fractures were of type A2.1 in 17 cases, type A2.2 in 23 cases and type A2.3 in 14 cases. There was no walking limitation in 45 patients, but 4 of the remaining 9 patients had walking limitations and used walking aids at their residence. A posterolateral approach as well as cementless femoral stems was used in all the patients. Clinical results were evaluated according to operation time, amount of bleeding, time to resume walking, duration of hospital stay, recovery of walking ability, and complications. Prostheses loss was evaluated on the follow-up radiographs.
Results
Twenty-two of 39 patients who had medical co-morbidity had more than two medical co-morbidities. Operations were performed at a mean time of 5.5 days after the fracture. The mean operation time was 95 minutes. The average total amount of bleeding was of 715 cc. Patients began walking at an average of 5.9 days after operation and the average duration of hospital stay was 19.2 days. Sixteen patients (29.6%) died at an average period of 1.6 years after their operation. At the time of discharge, 32 patients (59%) had recovered walking ability, but at the last follow-up compared to the pre-injury status, the recovery rate of walking had decreased to 46% (25 patients). Complications included a deep infection in one case, dislocation in 2 cases and hematoma in 2 cases. The cause of revision was deep infection. There were no revisions due to prosthesis loosening.
Conclusion
Cementless bipolar hemiarthroplasty for intertrochanteric fractures in the elderly had some problems due to the prolonged operation time and increased amount of bleeding, but it also had advantages including the early return to walking after the operation and decreased hospital stay. It is one of the treatment options for the elderly with unstable intertrochanteric fractures.
Figures and Tables
Figure 1
A 67-year-old woman with AO type A2.2 intertrochanteric fracture (A). The fractured greater trochanter (GT) was fixed with circular wire and non-absorbable suture. She could walk using a walking aid 3 days after operation (B). The last follow-up radiograph shows union of GT and a stable fixation of femoral prosthesis (C).
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