Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture

Abstract

Introduction: Although the treatment of choice for unstable intertrochanteric fractures in elderly patients has been internal fixation for a long time, several studies have shown mechanical and technical failures. Primary cemented bipolar (PCB) hemiarthroplasty has been proposed as an alternative with some advantages concerning earlier mobilization and minimal postoperative complications.Materials and Methods: This is a prospective cohort hospital-based study conducted at three tertiary hospitals over a period of two years. A total of 98 patients were enrolled in the study, 38 patients treated with Dynamic Hip Screw (DHS) and 60 patients treated with PCB hemiarthroplasty. Intraoperative events (e.g. duration of surgery and blood loss), hospital stay, weight bearing, Harris Hip score and post-operative complications were used as predictors of final outcome. Mean follow-up was 13.66±5.9 months in hemiarthroplasty group and 11.8±2.7 months at internal fixation group.Results: The two groups were comparable in age, sex, comorbidity, mode of trauma, and classification of fracture. Early mobilisation was significantly better in hemiarthroplasty (p<0.001) where 93.3% of patients started partial weight bearing on postoperative Day 1, while in the DHS group, 73.7% of patients started partial weight bearing after two weeks postoperatively. At the final follow-up, the mortality rate did not differ between the two groups, but general and mechanical complications were more common in the DHS group. The mean Harris Hip score was better in the hemiarthroplasty group (91.14 vs 74.11).Conclusion: Primary cemented bipolar hemiarthroplasty is a safe and valid option in treating unstable intertrochanteric fracture. Although it has been shown to have some advantages over DHS in certain circumstances, lack of randomization and difficulties in standardization of patients and treating surgeon raise a need for more studies with bigger sample size and proper randomization.

Cemented hemiarthroplasty versus proximal femoral nail antirotation in the management of intertrochanteric femoral fractures in the elderly: a case control study

“…In addition, the time required to reduce the incidence of fracture is an important variable that cannot be standardized. The greater postoperative reduction in hemoglobin and albumin levels is also similar to the findings of a large multicenter study by Ekinci et al that compared arthroplasty and internal fixation [ 23 ].…”

“…We used the claw hook to adduct the greater trochanter to facilitate cutting off the lateral rotator muscles, thereby opening the joint capsule and subsequent osteotomy of the femoral neck. Third, as Gashi et al reported in 2018, titanium cable or cementum can be used for greater trochanter fixation and intertrochanteric reinforcement [ 23 ].…”

“…They had better scores in walking support, walking distance, stairs, and hip joint mobility and better pain scores. The multicenter comparison by Ekinci et al did not find significant differences in terms of the total Harris score after arthroplasty vs. fixation; however, certain sub-parameter scores were quite different, with patients reporting less pain and need for walking support and better walking distance and stair climbing after HA [ 23 ]. Our outcomes are contrary to those reported by Tang, who found that although the total Harris score was not different between the arthroplasty and PFNA groups, the fixation group had better scores in most of the sub-parameters, which suggests that PFNA ultimately allowed more social functionality [ 26 ].…”

“…4 A, B). Ekinci et al and Tang et al have also reported declining Harris scores with age [ 23 , 28 ]. Functional outcomes are influenced by many factors, including age, gender, underlying disease, social dependency, and postoperative complications [ 29 ].…”

Total hip arthroplasty for intertrochanteric fracture fixation failure

“…Increasing age and osteoporosis present treatment issues due to compromised biomechanical structural strength of the femur. Additionally, internal fixation loosening, cutting, nonunion, coxa vara and other problems may occur following treatment [7–9].…”