Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70years: Boon or bane?

Abstract

The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70years). Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12months. Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2days (1-8days). The average duration of surgery was 58 ± 6min (44-96min) with an average blood loss of 126 ± 24mL (90-380mL). HHS at the end of 12months was 77. The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.