Primary Hemireplacement Arthroplasty in the Management of Unstable Intertrochanteric Fractures

BACKGROUND Intertrochanteric fractures(1) are a major cause of morbidity and mortality in the elderly population. They make up to 55% of all hip fractures. 35-40% of these fractures are unstable three- and four-part configurations with displacement of posteromedial cortex. Comminuted and unstable(2) inter-trochanteric fractures in the elderly osteoporotic patients pose challenging problems with increased rate of morbidity and mortality. Conservative treatment with traction and prolonged immobilization result in several dreaded complications. Surgery in these fractures is very important for the prevention of complications associated with conservative treatment like pressure sores, pulmonary infection, atelectasis, malunion etc. Osteosynthesis(3) by internal fixation does provide immediate fracture fixation, but in elderly patients with osteoporotic bones, complications like implant loosening, implant penetration, loss of fixation, cut through of implant are not uncommon. As a result, unstable intertrochanteric fractures in elderly patients are associated with high rates of morbidity and mortality(4) METHODS In our study during the period from April 2017 to April 2019, 30 patients with comminuted intertrochanteric fracture femur were operated by using the cemented bipolar prosthesis at Osmania General Hospital who were more than 70 years of age with osteoporotic bone. RESULTS Functional evaluation was done by Harris hip score. Excellent to fair results were obtained in 28 (93%) cases, and in 2 (7%) cases the results were poor. Mean hospital stay was 12+/- 0.6 days. There was one case of a superficial operative site infection and one case of a deep infection. There was one case with implant loosening(5), and sinking noted in one case. Limb length discrepancy was noted in 3 cases. Osteoporotic bones with comminuted fractures do not provide a good purchase for the implants, which subsequently leads to an early implant failure resulting in collapse of the fracture. Early mobilization is very essential particularly in patients with other medical co-morbidities. Both, stability and early ambulation are only possible with primary cemented hemiarthroplasty. It thus helps in preventing postoperative complications of prolonged recumbency such as pressure sores, pneumonia, atelectasis, etc. The concept of dual bearing surfaces offers considerable advantages, it results in sharing of motion at two surfaces and thus reducing erosion(6) at the acetabular joint surface. CONCLUSIONS Primary hemi replacement bipolar arthroplasty offers early painless mobility, ease of rehabilitation and early return to function, especially in complex trochanteric fractures, in the elderly and osteoporotic group. Our results are comparable to previous studies described in literature.