Hemiarthroplasty (HA) with a Two-Step Osteotomy in Unstable Intertrochanteric Osteoporotic Fractures of Senile Patients (A Report of 65 Cases)

Abstract

Background: Although Hemi Arthroplasty (HA) remains controversial, it has been the supplement in the treatment of unstable intertrochanteric osteoporotic fractures in senile patients. A newly designed two-step osteotomy with hemiarthroplasty was introduced in this study. Methods: Sixty five consecutive patients (aged from 75 to 92 years with a mean of 81 years old) with unstable intertrochanteric fractures including 21 male cases (21 hips) and 44 female cases (44 hips) were treated in our hospital from August 2006 to October 2015 (Evans type III in 20 casesi¼ŒEvans type â…£ in 45 cases) with a newly designed two-step osteotomy technique with bipolar hemiarthroplasty by a senior orthopedic surgeon through posterior approach under general anesthesia. All cases were evaluated by Zuckerman functional recovery score (FRS) [1] and operative risk assessment software 1 (ORAS1), based on the Possum and P-Possum score system [2]. The duration and blood loss have been recorded. All prostheses consisted of Link SP II femoral stem and bipolar femoral head and were followed up for more than 1 year. Results: The average pre-injured FRSi¼Œpredictive value of operative morbidity and mortality were 82.7 (8 1.6—84.9), 9.2%(7.1%--14.9%) and 3.4%(2.1%--4.3%), respectively. The average operation time was 50 minutes with a mean intra operative blood loss of 310 m1. There were no operative or anesthetic complications or deaths within 30 days after operation. Sitting up was permitted 3 to 4 days, and partial weight beating was allowed 5 to 7 days after operation. The average FRS was 78.3 at 30 days and 83.9 at 1 year postoperatively. Eleven patients died of unrelated causes (Five due to myocardial infarction and the others due to cerebral hemorrhage during at least one-year follow-up) (table 1)i¼Ž Conclusion: Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fractures in the senile patients is a good choice for early ambulation and good hip function. Internal fixation (IF), especially with intramedullary nail, has been the gold standard in the treatment of unstable intertrochanteric osteoporotic fractures in senile patients. However, high internal fixation failure rate because of severe osteoporosis, coxa vara, displaced greater and lesser trochanters, makes orthopedic surgeon puzzled in the decision making. Although it remains controversial, hemiarthroplasty (HA) has been the supplement in the treatment, because bipolar hemiarthroplasty can not only achieve early mobilization but also get good hip function. But because of difficult anatomical reduction, poor bone quality, local complicated anatomical structure and many comorbidities, The surgical technique remains challenging to orthopedic surgeon. The purpose of this study was to introduce bipolar hemiarthroplasty with a newly-designed two-step osteotomy technique and observe its clinical result for unstable intertrochanteric fractures in senile patients. Keywords: Hemiarthroplasty, Osteoporosis, Intertrochanteric Fracture