Study of intertrochenteric fracture treated by bipolar hip replacement

Abstract

Introduction: Unstable intertrochanteric fractures in osteoporotic bones are difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure in internal fixation, with dynamic hip screws or intramedullary nail has been found high, especially in osteoporotic bones. The weak and porotic bone tolerates screws poorly so cut out is the major problem in internal fixation. The purpose of this study was to determine whether hemiarthroplasty is a reasonable alternative method of treatment for elderly patients in intertrochanteric fracture with osteoporosis to reduce mortality and morbidity in terms of full weight bearing and complications related to prolonged bed rest. Material and methods: 15 patients (6 males and 9 females) above 60 years of age with unstable intertrochanteric fractures who underwent bipolar arthroplasty were prospectively evaluated. Transtrochanteric approach was used in all patients. Greater trochanter tension band wiring was done in some patients. Harris hip score was used for the clinical evaluation. The minimum follow up period was one year. Results: In our study 15 cases were taken, which had a mean age 75years. The mean Harris hip score at one year was 85. Excellent to good results were obtained at one year in 12 cases and fair in 2 cases, poor in 1. Death of two patients occurs due to age related factors. There was one case of superficial infection. Radiological follow-up showed no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis. Conclusion: In conclusion we state that hemireplacement arthroplasty is a valid treatment option for mobile and mentally healthy patients. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patients to maintain a good level of function beginning in the immediate post-operative period. But the follow up period in our study is not enough to make any clinical recommendations though it can serve as a critical analysis to stimulate future research. Further long-term studies are required.