Abstract: Background: Unstable pertrochanteric fractures pose a significant health problem in elderly home-ambulant patients with increased morbidity and mortality, and their attendant co-morbidities.
Objective: To study the functional outcome of cemented hemiarthroplasty in home ambulant elderly patients with unstable pertrochanteric fractures.
Methods: A hospital-based, prospective, non-randomized study between September 2013 and September 2019. All patients aged 65 years and above with unstable pertrochanteric fractures were included with the exception of those who were non-ambulant before injury and those with histologically confirmed tumors. Harris Hip Scoring (HHS) was done for all patients on both hips pre- and postoperatively. Cemented bipolar hemiarthroplasty was done using cement mantle to reconstruct the calcar, and biopsy was taken for histology at surgery. Subperiosteal detachments of the iliopsoas muscle and adductor tenotomy were done when indicated. Full weight-bearing ambulation was commenced on the second postoperative day. Data was analyzed using SPSS version 23 for windows.
Results: Forty-eight hips in 47 patients were analyzed. The mean age was 83.4 +/- 5.0 years with a F: M ratio of 2.4:1. Average duration of presentation was 26.4 +/- 12.8 days as all the patients had had traditional bone setters’ treatment prior to their presentation. Hypertensive heart disease was the commonest co-morbid condition. The mean operation time was 77.9 +/-9.5 minutes (range 60-98 minutes). The mean estimated blood loss (EBL) was 385.6 +/- 198.2 ml (range 150-850ml). Twenty-two (45.8%) patients were transfused. All patients ambulated at second postoperative day. Forty-seven (97.92%) hips had good and excellent functional outcomes at 12 weeks, and 46 (95.83% of total hips studied, but 100% of those still alive) had good to excellent functional outcomes at 2 years with p value < 0.0005. A patient had both hips recruited 2 years apart. A deep surgical site infection and two limb length discrepancies were associated complications. Two (4.26%) of the patients died of unrelated causes before the end of the first year of follow up.
Conclusion: Primary cemented bipolar hemiarthroplasty allows early weight bearing and produces good to excellent functional outcomes in home-ambulant elderly patients with unstable pertrochanteric fractures with minimal complications.
