Role of hemiarthroplasty in intertrochanteric fractures in elderly osteoporotic patients: a case series

Management of intertrochanteric fractures in elderly osteoporotic patients continues to be a challenging problem for orthopedic surgeons. Cutting out of implant from the femoral head and varus malpositioning of fragments is often seen in such cases if early ambulation is allowed. Prolonged bed rest in elderly patients leads to higher risk of complications such as bed sores, pneumonia and deep vein thrombosis not uncommonly leading to fatal pulmonary embolism. The purpose of this case series study was to assess the role of hemiarthroplasty in the treatment of intertrochanteric fractures in elderly patients and study the complications. Twenty-five patients were treated at a tertiary care center with hip hemiarthroplasty in intertrochanteric fractures. Mean age of the patients in the study was 77.8 years. Young patients with stable fractures and patients with active infection were excluded from study. Seventy-two percent of patients in the study were osteoporotic and associated comorbidity was present in 18 patients. Preoperative ambulatory status of all patients was noted for comparison. If calcar was deficient, calcar was reconstructed with a cut autograft from the femoral neck. All Patients were followed for 1 year and evaluated using Modified Harris Hip Score except one patient who expired in postoperative period probably due to embolism. He had poor cardiopulmonary reserve preoperatively and cement was used in this case. Average period of initiation of full weight bearing in the present study was 5.5 days. Excellent/good results were seen in 20 patients (80%). One of the patients, who remained bedridden even after surgery, developed decubitus ulcer on the back and was labeled as failure. This patient expired 9 months after surgery. Dislocation of prosthesis was not seen in any case. One patient had shortening more than 1.5 cm due to sinking of prosthesis. Although majority of patients with intertrochanteric fractures can be successfully managed with osteosynthesis, older patients with severe osteoporosis and associated comorbidity may benefit from prosthetic replacement. However, large scale studies are required to prove it conclusively.