Yeesuk KIM, Jun-Ki MOON, Kyu-Tae HWANG, Il-Yong CHOI, Young Ho KIM

Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians

Objective: The aim of this study was to evaluate the clinical and radiographic outcomes of bipolar hemiarthroplasty with cementless stem for the unstable intertrochanteric fracture in octogenarians and to determine the influencing factors associated with subsidence of the stem.Methods: The study included the 143 hips of 139 patients (119 females, 20 males). Mean followup period was 3.8 (range: 2.2 to 9.0) years. The displaced lesser trochanteric fragment was reduced anatomically and fixed with 16-gauge stainless steel cerclage wire. Clinical outcomes included Harris Hip Score (HHS), thigh pain, groin pain and walking ability. Radiographic outcomes included stem fixation and stability, osteolysis, heterotopic ossification and subsidence. The stable reduction group was determined when anatomic reduction of posteromedial fragments was achieved with <=1 mm gap of fragment.Results: Mean HHS was 82 (range: 78 to 99) at the final follow-up. Thirty-one hips (21.7%) experienced thigh pain and 19 (13.3%) groin pain. One hundred and twelve patients (80.6%) regained their pre-injury level of ambulation. All femoral stems showed osseointegration without aseptic loosening and osteolysis. The mean stem subsidence was 3.1±2.4 (range: 0 to 18) mm. The extent of subsidence was significantly higher in patients with unstable reduction. The survival rate was 94.2%.Conclusion: Cementless bipolar hemiarthroplasty appears to be a suitable method for the treatment of intertrochanteric fracture in octogenarians. However, stable fixation of the posteromedial fragment is necessary to avoid stem subsidence.

___

Johnell O, Kanis JA. An estimate of the worldwide preva- lence, mortality and disability associated with hip fracture. Osteoporos Int 2004;15:897-902.

Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am 2003;85-A:899-904.

Lee YK, Ha YC, Chang BK, Kim KC, Kim TY, Koo KH. Cementless bipolar hemiarthroplasty using a hydroxyap- atite-coated long stem for osteoporotic unstable intertro- chanteric fractures. J Arthroplasty 2011;26:626-32.

Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 2002;26:233-7.

Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty 2005;20:337-43.

Kim SY, Kim YG, Hwang JK. Cementless calcar-re- placement hemiarthroplasty compared with intramed- ullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005;87:2186-92.

Chen YT, Chen WM, Lee KS, Huang CK, Chiang CC, Chen TH. Diaphyseal locking hip arthroplasty for treat- ment of failed fixation of intertrochanteric hip fractures. J Arthroplasty 2008;23:241-6.

Paul O, Barker JU, Lane JM, Helfet DL, Lorich DG. Functional and radiographic outcomes of intertrochan- teric hip fractures treated with calcar reduction, compres- sion, and trochanteric entry nailing. J Orthop Trauma 2012;26:148-54.

Koval KJ, Aharonoff GB, Rosenberg AD, Bernstein RL, Zuckerman JD. Functional outcome after hip fracture. Effect of general versus regional anesthesia. Clin Orthop Relat Res 1998;348:37-41.

Harris WH. Traumatic arthritis of the hip after disloca- tion and acetabular fractures: treatment by mold arthro- plasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55.

Engh CA, Glassman AH, Suthers KE. The case for po- rous-coated hip implants. The femoral side. Clin Orthop Relat Res 1990;261:63-81.

Engh CA, Hooten JP Jr, Zettl-Schaffer KF, Ghaffarpour M, McGovern TF, Macalino GE, et al. Porous-coated total hip replacement. Clin Orthop Relat Res 1994;298:89-96.

Gruen TA, McNeice GM, Amstutz HC. "Modes of fail- ure" of cemented stem-type femoral components: a ra- diographic analysis of loosening. Clin Orthop Relat Res 1979;141:17-27.

Meijerink HJ, Gardeniers JW, Buma P, Lemmens JA, Sch- reurs BW. Hydroxyapatite does not improve the outcome of a bipolar hemiarthroplasty. Clin Orthop Relat Res 2004;421:143-50.

Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Inci- dence and a method of classification. J Bone Joint Surg Am 1973;55:1629-32.

Kaplan EL, Meier P. Nonparametric estimation from in- complete observations. J Am Stat Assoc 1958;53:457-81.

Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF; Evidence-Based Orthopaedic Trauma Working Group. Unstable pertrochanteric femoral fractures. J Or- thop Trauma 2005;19:63-6.

Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bi- polar arthroplasty compared with internal fixation. J Bone Joint Surg Am 1989;71:1214-25.

Koval KJ, Sala DA, Kummer FJ, Zuckerman JD. Postop- erative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg Am 1998;80:352-6.

Kayali C, Agus H, Ozluk S, Sanli C. Treatment for un- stable intertrochanteric fractures in elderly patients: inter- nal fixation versus cone hemiarthroplasty. J Orthop Surg (Hong Kong) 2006;14:240-4.

Böhm P, Bischel O. Femoral revision with the Wagner SL revision stem : evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am 2001;83-A:1023-31.

Fan L, Dang X, Wang K. Comparison between bipolar hemiarthroplasty and total hip arthroplasty for unstable intertrochanteric fractures in elderly osteoporotic patients. PLoS One 2012;7:e39531.

Sancheti Kh, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteopo- rotic intertrochanteric fractures in the elderly: A retro- spective case series. Indian J Orthop 2010;44:428-34.

Apel DM, Patwardhan A, Pinzur MS, Dobozi WR. Axial loading studies of unstable intertrochanteric fractures of the femur. Clin Orthop Relat Res 1989;246:156-64.

Weber M, Hempfing A, Orler R, Ganz R. Femoral revi- sion using the Wagner stem: results at 2-9 years. Int Or- thop 2002;26:36-9.

Stern MB, Angerman A. Comminuted intertrochanteric fractures treated with a Leinbach prosthesis. Clin Orthop Relat Res 1987;218:75-80.

Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal fem- oral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012;43:876-81.

Choy WS, Ahn JH, Ko JH, Kam BS, Lee DH. Cement- less bipolar hemiarthroplasty for unstable intertrochan- teric fractures in elderly patients. Clin Orthop Surg 2010;2:221-6.