Bipolar Hemiarthroplasty by Using Cemented Calcar Replacement Stem for Unstable Inter-trochanteric Fractures in Old Age

Abstract

Background: Internal fixation of unstable inter-trochanteric is challenging and most of the morbidity is associated with prolonged immobilization and implant cut outs. Aim of this study is to evaluate clinical outcomes of bipolar hemiarthroplasty in old age patients with unstable inter-trochanteric fractures by using cemented calcar replacement stem. Methods: 80 hips of inter-trochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3) in 80 patients, 49 females and 31 male patients from Aug 2016 to Sept 2019. All the patients were operated by posterolateral approach, and hemi-replacement done using cemented modular calcar replacement stem, greater trochanter also reconstructed in all the patients. Patients were followed at 6 wks, 3 months, 6 months and 1 year. Primary outcome included Harris hip score and secondary outcome includes functional walking ability (kovals), thigh pain, dislocation, trendelenberg test and infection, mortality. Results: No dislocation, No e/o infection, only two patients complained of anterior thigh pain. One patient developed pulmonary embolism treated and recovered, limb length discrepancy seen in 4 patients (lengthening 4, no shortening) range 0-20 mm, Perioperative mortality during hospitalization is seen in two patients due to cardiac complications. 5 patients died from discharge to within one year. 3 patients lost to follow up. Fifty five patients (78.57%) regained preinjury ambulation status at final follow up. At final follow up, Average Harris hip score (HSS) was 80 (Range 70 to 95) , poor (<70)-3, fair(70-79)-12, Good (80-89)-50, Excellent (90-100)-5. Conclusion: Hemiarthroplasty using calcar replacement stem in unstable inter-trochanteric fracture in old age patients helps in early mobilization of patients and early regaining of preinjury ambulation status. keyword: Unstable inter-tochanteric fracture; Cemented bipolar; Calcar stem bipolar. Level of evidence: Therapeutic level II.