Hip arthroplasty in unstable trochanteric fractures in elderly

Author(s): Sisir Kumar Sahoo, Sidhartha Samal and Kalpit Sudhir Dhotkar

Abstract: Unstable osteoporotic intertrochanteric fractures are common in the elderly population. Failure rate of as high as 56% have been noted with internal fixation of unstable fractures mainly due to inadequate purchase in the osteoporotic bone and early full weight bearing. Hemiarthroplasty is a frequently employed alternative as it gives stability and allows immediate full weight bearing. This study evaluates the role of primary cemented hemiarthroplasty in the treatment of unstable trochanteric fractures in elderly and physiologically elderly patients. 30 elderly patients who were above 60 years of age with unstable osteoporotic intertrochanteric fractures, who underwent cemented bipolar hemiarthroplasty were studied prospectively from July 2017- july 2019. Patients who were less than 60 years of age, non ambulatory before injury and patients with stable intertrochanteric fractures, pathological fractures cognitive impairment were excluded from the study. Fractures were classified based on Boyd and Griffin classification. All the patients were treated with cemented bipolar prosthesis through posterior (Moore’s) approach. Mean follow up period was 12 months. Patients were assessed using modified Harris hip score. This study included 12 males and 18 female patients with mean age of 73. There were 24 patients with a byod and griffin type 2 injury and 6 patients sustained a byod and griffin tye 3 injury. The average intra operative blood loss was 357 ml and average operative time was 75 mins. On an average patients were allowed to bear full weight on 7th post operative day. 2 patients had superficial infection and 1 patient had a shortening more than 2 cms. 9 patients had abductor weakness. There were no cases of prosthetic dislocation, periprosthetic fracture, acetabular erosion and stem loosening. Primary cemented hemiarthroplasty for unstable osteoporotic elderly trochanteric fractures appears to be a good alternative treatment modality. Early full weight bearing and rehabilitation is a definitive advantage of this method.

DOI: https://doi.org/10.22271/ortho.2020.v6.i1p.1980