Cementless Bipolar Hemiarthroplasty Using a Rectangular Cross-section Stem for Type A2 or above Intertrochanteric Fractures

Bong-Ju Park; Hong-Man Cho; Cheol Park; Hwang-Se Bong

doi:10.5371/hp.2012.24.3.222

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Park, Cho, Park, and Bong: Cementless Bipolar Hemiarthroplasty Using a Rectangular Cross-section Stem for Type A2 or above Intertrochanteric Fractures

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(3): 222-230.

Published online: 30 September 2012

DOI: https://doi.org/10.5371/hp.2012.24.3.222

Cementless Bipolar Hemiarthroplasty Using a Rectangular Cross-section Stem for Type A2 or above Intertrochanteric Fractures

Bong-Ju Park, MD, Hong-Man Cho, MD, Cheol Park, MD, Hwang-Se Bong, MD

Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea.

Address reprint request to Hong-Man Cho, MD. Department of Orthopedic Surgery, Gwangju Veterans Hospital, 887-1 Sanwol-dong, Gwangsan-gu, Gwangju 506-705, Korea. TEL: +82-62-602-6162, FAX: +82-62-602-6164, chm1228@hanmail.net

Received 26 June 2012 Revised 6 September 2012 Accepted 6 September 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the treatment outcome for Type A2 or above intertrochanteric fractures in elderly patients using cementless bipolar hemiarthroplasties incorporating a standard (tapered, rectangular) stem.

Materials and Methods

We retrospectively reviewed the records of 37 patients who had undergone bipolar hemiarthroplasty between February 2006 and February 2010 in our hospital, and who had received follow up evaluation for more than two years after the surgery. The mean patient age was 73.5 years (range 65-88 years), and 16 patients were male and 21 were female. We evaluated the the results of their treatment by analyzing the operation duration, volume of bleeding, measured results for the recovery of walking capability, and any complications and radiologic findings.

Results

The mean operation duration was 75.3 minutes(50-185 minutes). The average total volume of bleeding was of 755.5 cc(75-1,400 cc). Upon the final follow-up visit, 27 patients(72.9%) had recovered more than 80% of their pre-injury Barthel index values(72.8±15.1). Complications included one case of deep infection, one case of acetabular erosion, and 3 cases of greater trochanter non-union. There were no cases of revisions due to prosthesis loosening or for other reasons.

Conclusion

Cementless bipolar hemiarthroplasty using a tapered, rectangular stem is a viable alternative treatment for type A2 intertrochanteric fractures in elderly patients which supports rapid patient mobilization ability.

Keywords: Hip, Intertrochanteric fracture, Osteoporosis, Hemiarthroplasty, Centlmeess stem

Figures and Tables

Fig. 1

Photograph of the double loop wiring technique and wiring position.

Fig. 2

(A) A 83-year-old man patient had a A2 type intertrochanteric fracture. (B) The postoperative radiograph shows a good diaphyseal canal fit and wiring. (C) At postoperative 24 months, the radiograph shows stable fixation of the femoral stem.

Fig. 3

(A) A 85-year-old woman patient had a A3 type intertrochanteric fracture. (B) The postoperative radiograph shows a good diaphyseal canal fit and wiring. (C) At postoperative 6 weeks, the radiograph shows greater trochanteric fragment was displaced superioly. (D) At postoperative 24 months, the radiograph shows stable fixation of the femoral stem and united greater trochanter.

Fig. 4

(A) A 82-year-old woman patient had a A2 type intertrochanteric fracture. (B) The postoperative radiograph shows a good diaphyseal canal fit and wiring. (C) At postoperative 24 months, radiographs showing non-union state of a greater trochanteric fragmnent, however greater trochanter non-union were treated by conservative methods because of non-specific patients complaints.

Table 1

Dermographic Data

^*yrs: Years, ^†A: AO Classification, ^‡RT: Right, ^§LT: Left.

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