Cemented Hemiarthroplasty in Elderly Osteoporotic Unstable Trochanteric Fractures using Fracture Window

Study of outcomes of cemented hemiarthroplasty for comminuted intertrochanteric fractures in the elderly

Aims & objectives

To assess the functional outcomes of the unstable intertrochanteric fractures in the osteoporotic individuals treated by primary cemented hemiarthroplasty by early mobilization and immediate weight-bearing, restoration of limb length, and gait Assessment.

Materials and methods

It is a prospective study of 17 elderly patients with comminuted intertrochanteric fractures managed with cemented hemiarthroplasty attending to the Department of Orthopaedics, Government General Hospital, Rangaraya medical college, Kakinada.

Results

17 cases of unstable intertrochanteric fractures were treated with cemented bipolar hemiarthroplasty. The average follow-up period was 12 months. The average age was 72.75 years with a standard deviation of 5.56. Most (82.3%) of the patients presented with Boyd and Griffin type 2 fracture. The functional assessment by HHS showed good to excellent outcomes in most of the patients (64.7%). 2 patients had abductor weakness, 1 patient had superficial surgical site infection, one had hypotension, and 1 patient had bedsore.

Conclusions

Primary cemented bipolar prosthetic replacement in comminuted intertrochanteric fractures in the elderly patients provide s painless, stable, and mobile hip joint so that we can institute early postoperative mobilization which can avoid the consequences of prolonged recumbency. Hemiarthroplasty also avoids a second procedure in such elderly patients with multiple comorbidities as there is a high risk of failure of internal fixation in patients with poor bone quality, subjecting them to a second surgery and anaesthesia being a risky proposition.

Association of Hip Fracture With the Use of Walking Assistance Devices Post-surgery: A Retrospective Study Comparing Intertrochanteric and Subtrochanteric Hip Fractures

Background Hip fractures, including intertrochanteric and subtrochanteric fractures, are among the most common types of fractures. The dynamic hip screw (DHS) and the cephalomedullary hip nail (CHN) are the two main techniques used for the fixation of these types of fractures. This study aims to explore the association of the fracture type with the use of walking assistance devices post-surgery, regardless of the fixation technique. Methodology This study is a retrospective study based on the review of de-identified patient data from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged 65 years old or above who underwent fixation procedures for intertrochanteric or subtrochanteric fractures using CHN or DHS techniques were included in this study. Results A total of 8,881 patients were included and divided into the following two groups: 876 (9.9%) patients treated for subtrochanteric fracture, and 8,005 (90.1%) patients treated for intertrochanteric fracture. No statistical significance was detected in the use of mobility aid postoperatively between the two groups. When compared to CHN, DHS was noted to be the most employed fixation technique among patients with intertrochanteric fractures. One main finding was that patients who underwent surgery using DHS for intertrochanteric fractures were more likely to use walking assistance devices postoperatively compared to those with subtrochanteric fractures treated with the same fixation technique. Conclusions Findings suggest that the use of walking assistance devices post-surgery is independent of the type of fracture and potentially dependent on the fixation technique employed. Future studies focused on the difference in the use of walking assistance devices based on fixation techniques for patients with distinctive sub-types of trochanteric fractures are highly encouraged.

Evaluation of functional outcome and comparison of three different surgical modalities for management of intertrochanteric fractures in elderly population

INTRODUCTION

The purpose of this study was to compare the role of the various surgical modalities ie, Hemiarthroplasty (HA), Dynamic Hip Screw (DHS), Cephalo-medullary nail (CMN) in the management of intertrochanteric fractures in elder patients with comparison of the results and assessment of the complications encountered with each method.

METHODS

Total 105 adult patients having intertrochanteric fractures managed during July 2013 to December 2018 at tertiary trauma care centre and followed for minimum 12 months were included in the study. Patients were divided into three groups. Primary hemiarthroplasty was done in 35 patients (group A) while DHS and PFN was done in 35 patients each in group B and group C respectively. Functional evaluation was done using Modified Harris Hip score (HHS) at different intervals while ambulatory function was measured using the Parker Mobility Score.

RESULTS

The mean age of patients was 72.14±2.9 years. Mean operative time and blood loss in group A was significantly higher than the other two groups. Hemiarthroplasty group could ambulate earlier than DHS/PFN group. Mean HHS at final follow up was 85.40±7 in group A while in group B and group C these values were 76.36±16.45 and 86.85±10.52 respectively. HHS was significantly higher (P, 0.01) in hemiarthroplasty group in comparison to DHS group. Post-operative complications were comparable in all the groups.

CONCLUSION

We support the use of hemiarthroplasty for unstable intertrochanteric fracture in elderly patients with lesser failure rates, early mobilization and better functional outcomes. Early mobilization and less hospital stay should be the goal of every surgical procedure in the elder population.

[Progress on reconstruction of proximal femur in the hemiarthroplasty for intertrochanteric fracture with distal fixated long stem]

OBJECTIVE

To summarize the application of distal fixated long stem in the treatment of intertrochanteric fracture (ITF) in the sequence of proximal femoral reconstruction, fixation materials, and other details after operation, in order to improve doctor's attention to the reconstruction of the proximal femur and reduce complications.

METHODS

The related literature about the application of distal fixated long stem in the treatment of ITF was extensively reviewed, summarized, and analyzed.

RESULTS

The sequence of reconstruction is divided into fracture reconstruction priority and prosthesis reconstruction priority. The former is mainly to provide an anatomical reference for the placement of joint prostheses, the latter is mainly to provide support for fracture fixation. The distal fixated cement long stem and cementless long stem have their own characteristics, and materials of reconstruction are used in combination. There is no uniform standard for the sequence and materials of reconstruction.

CONCLUSION

Although the stability of the distal fixated long stem depends on the distal femur, the accurate reconstruction of the proximal femur is still worthy of attention.

Primary bipolar hemiarthroplasty as a treatment option for unstable intertrochanteric fractures

OBJECTIVES

Management of unstable intertrochanteric fractures is challenging, especially in patients with osteoporosis. Comminuted unstable intertrochanteric fractures require postoperative immobilization. Several recent reports have recommended hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for unstable intertrochanteric fractures in older persons.

METHODS

Sixty patients aged over 75 years underwent hemiarthroplasty to treat unstable intertrochanteric fractures and were followed up over 12 months. All surgeries were performed by the same surgical team using the standard posterolateral approach. Wires, cables, and plates were used as required. Use of cemented protheses was considered when the lesser trochanter had been displaced. All patients were allowed full weight-bearing as tolerated. Clinical evaluation was based on Harris Hip Scores.

RESULTS

The cohort comprised 16 men and 44 women (aged 75-96 years). According to the Jensen classification, 24 fractures were type III, 14 type IV, and 22 type V. Cement was used in 24 patients. At 12 months follow-up, Harris Hip Scores were excellent in 18%, good in 42%, fair in 25%, and poor in 15%. No radiological abnormalities were detected.

CONCLUSIONS

Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures eliminates the need for prolonged immobilization and permits early ambulation. As reported by others, hip hemiarthroplasty is an effective treatment choice for unstable intertrochanteric femoral fracture in older patients.

The effect of surgery type on mortality in elderly patients with pertrochanteric femoral fracture: A Korean nationwide cohort study

BACKGROUND/OBJECTIVE

The purpose of this study is to analyze the effect of surgical methods on mortality and the relative risk of patients who underwent internal fixation (IF) or hemiarthroplasty (HA) after being diagnosed as a pertrochanteric fracture over 65 years old in a Korean nationwide cohort with a single insurance medical system.

METHODS

The Korean National Health Insurance Service-Senior cohort (NHIS-Senior, NHIS-2018-2-111) was used in this study. The eligibility criteria for incident hip fracture patients were the following: (1) first-time admission to acute care hospitals (index admission) with pertrochanteric fracture (ICD-10 S721), (2) three years of hip fracture-free period, (3) recipients of typical surgeries including IF, HA, (4) age between 65 and 99.

RESULTS

a total of 7223 patients were enrolled in the cohort. There were 1662 patients (23%) in the HA group and 5561 patients (77%) in the IF group. Mortality rates of the IF group and HA group were 13.46 and 17.94 cases per 100 person-years, respectively. In the multivariable-adjusted Cox proportional hazard model, the HA group had 1.22 times more hazard of all-cause mortality than IF group (aHR 1.22, 95% CI 1.13-1.32). In subgroup analysis, aged 65-79 and female patients showed a prominent association between surgery type and mortality (aHR 1.52, 95% CI 1.29-1.79).

CONCLUSIONS

In patients with pertrochanter fracture over 65 years, 1.22-fold mortality rate was observed when HA was performed compared to that of IF, and the difference in mortality was particularly prominent within 1-year after surgery.

Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty

A prospective, comparative study was done over a period of 3 years to compare the complications and functional results of two treatment modalities of unstable intertrochanteric fractures of the femur in the elderly; i.e closed reduction and internal fixation (CRIF) with proximal femur nail (PFN) and primary cemented hemireplacement arthroplasty (HRA) with bipolar prosthesis. 100 elderly patients with unstable intertrochanteric fractures of femur were studied over a period of 3 years. 50 patients underwent CRIF with PFN and 50 patients were treated with primary cemented hemireplacement arthroplasty with bipolar prosthesis. Harris Hip score analysis revealed that the difference between the patients treated with cemented hemiarthroplasty and proximal femoral nailing was statistically significant in favour of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point and reversed at the 12 month time point indicating a better functional outcome of Proximal Femur Nail in the long term. Although cemented hemireplacement arthhroplasty allows early pain free mobilization and has a good short term outcome, over time it is associated with a variety of complications which significantly affects quality of life of patients. On the other hand, although patients treated with PFN had delayed post op mobilization, they had better results when followed up at 1 year post surgery.

Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis

Purpose

This study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies.

Materials and Methods

Systematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types.

Results

There were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03).

Conclusion

Cemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.