Primary Cemented Bipolar Hemiarthroplasty With Trochanteric and Calcar Reconstruction in Unstable Intertrochanteric Fractures in Elderly: A Prospective Study

Abstract

To avoid the complications and morbidity associated with attempted Osteosynthesis of the so called Unstable inter-trochanteric fractures in the elderly population, Primary Cemented Bipolar hemiarthroplasty been around for over three decades now. But, hardly any emphasis been given over the technical aspects to improve the functional outcome. Present study is one such, following reconstructive attempts (Of primary cemented bipolar hemiarthroplasty) with trochanter and calcar reconstruction in the elderly population to reduce the risk of unstable Hemiarthroplasty. MATERIALS AND METHODS: This prospective study included 20 cases of elderly patients with mean age of 73.5 years (Age range 66 to 82 yr) who sustained multifragmentary/communited inter-trochanteric femur fracture treated with Primary cemented bipolar hemiarthroplasty with trochanteric and calcar reconstruction to emphasize the importance of restoration soft tissue tension to reduce the risk of unstable Hemiarthroplasty. Essential Technical steps include Figure of eight/ multiple wire loop technique of reconstruction (with or without K 'wires) of greater trochanter/ abductor mechanism and calcar reconstruction either by wiring Lesser trochanteric fragment and or insertion of cortical piece of bone graft (medially under the collar of the prosthesis) harvested from head and neck fragment. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS). RESULTS: The mean HHS score was 85 (range 69 to 91) at the end of one year. The main clinical measures were early post-operative full weight bearing, post-operative complication & functional outcome. The time to full weight bearing, the rate of post-operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group. CONCLUSION: The authors strongly believe that primary cemented bipolar hemiarthroplasty with emphasis of restoration of abductor mechanism and calcar support is an ideal surgical strategy for unstable inter-trochanteric fractures of femur in elderly, so as to allow early ambulation, good functional outcome, stable hemiarthroplasty with minimal complications without the need for revision surgery.