Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing.

Abstract

Cephalomedullary (CM) nailing is widely used for the treatment of pertrochanteric hip fractures. Fixation failures with CM nailing tend to occur in unstable fracture patterns often necessitating revision surgery. The purpose of this study was to compare the complications and clinical outcomes of primary arthroplasty to CM nailing for the treatment of unstable pertrochanteric hip fractures. We conducted an age-, sex-, and fracture type-matched case-controlled study and identified 29 patients who underwent hip arthroplasty for an unstable pertrochanteric fracture (AO/OTA classification type 31A2.2/3 and 31.A3) at our institution. Their outcome was compared to a matched control group of 29 patients treated with a CM nail. There was one major complication in the arthroplasty group (3.4 %), whereas there were six major complications in the nailing group (20.7 %) (P = 0.04). We found no significant difference between the groups with regards to blood loss, operative time, hospitalization time and the number of patients discharged to rehabilitation. Clinical outcome measured with Oxford hip score and SF-12 at the time of final follow-up was not significantly different between the groups. Arthroplasty is a viable option for treatment of unstable pertrochanteric fractures in an elderly population. Arthroplasty may offer a lower re-operation rate in the treatment of unstable pertrochanteric hip fractures as compared to CM nailing.