1. Outcome of Primary Cementless Hip arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys
Su-Hyun Cho, MD., Hyung-Lae Cho, MD., Hong-Cho, MD.
Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea B A C D
Introduction
We report outcomes of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderly.
Material and Method
Patients
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.
Mar – Feb. 2012
35 hip replacements
(M/F = 14/21)
Selection criteria
1. loss of medial support
2. age > 70
3. osteoporosis ( Singh index < 4)
Two type of stem
stem 1 ; monoblock
stem 2 ; modular
(Lima-Lto)
Retrospective study
operative time,
transfusion amount,
hospital stay
time to full weight bearing.
Clinical outcome
Parker and Palmer (P&P) mobility score
Harris hip score (HHS).
Radiological outcome
bone healing of fractured trochanter
subsidence
canal fill index
stress shielding
Posterior approach
Primary stability ; inevitable
Added stabiity by screw or wire
Acetabular replacement
> Tonnis grade, 1
> Acetabular index,10°
Mann-Whitney U test A B C D
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.
Stem 1
Clinical outcome
preinjury
Last F/U
P-value
P&P score (mean)
7.1
6.5
>0.05
HHS (median) 81 75
Stem 2
Ambulatory status
Preinjury
Last F/U
Community and household
26 (74%)
22 (63%)
Nonfunctional and wheelchair-bound
9 (26%)
13 (37%)
Operative technique
Complications
Infection ; nil
stem subsidence ; nil
Linear periprosthetic
fracture ; 1
Dislocation of prosthetic
head (THA) ; 1
Acetabular erosion
developing to acetabular defect ; 1
Statistical analysis
Primary stability was achieved with monoblock rectangular stem (A) or modular fluted long stem (B).
Conclusion
Results
If carefully selected, cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderly in short term follow-up, but it is necessary to try to obviate rare complications such as postoperative dislocation or development of acetabular defect.
Mean F/U ; 15 mon. (range, mon.)
Average op time; 92 min. (range, min.)
Mean transfusion; 0.95 L (range, L)
Mean hospital stay; 29 days (range, days)
Mean time to FWB; 47 days (range, days)
Key Words: Hip, Intertrochanteric femur fracutre,
Hip replacement arthroplasty