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Primary cemented hemiarthroplasty for unstable intertrochanteric fractures in elderly severe osteoporotic patients

Xie Y1Zhou H2.

Injury. 2020 Jan 7. pii: S0020-1383(20)30010-3. doi: 10.1016/j.injury.2020.01.010. [Epub ahead of print]

 

 

Abstract

OBJECTIVE:

To evaluate the outcome of unstable intertrochanteric fractures with primary cemented hemiarthroplasty (HA) in elderly severe osteoporotic patients.

MATERIAL AND METHODS:

In January 2009 to July 2017, 277 patients were selected according to inclusion criteria and results were analyzed prospectively. According to AO/OTA Classification, only type 31-A2.2(148 cases) and 31-A2.3(129cases) were included. 53 cases were males and 224 cases were females. The mean age was 75.4 years. The mean follow-up period was 50 months. The Harris Hip Score (HHS) and perioperative index (including the time duration of the surgery, intraoperative blood loss, postoperatively weight bearing time, implant complications) were analyzed clinically.

RESULTS:

Follow-up evaluations were performed at 6 weeks, 3, 6, 9 and 12 months, and every year thereafter (mean 50 months). The average duration of surgery was 43.2 min (range 21-65 min), with a mean blood loss of 225.8 ml (range 70-425 ml). All patients were out of the bed and mobile with help of walker with average of 3.3 days (range 1-5 days). The average duration of hospital stay was 12.3 days. Average HHS improved from 83.7 (range 63-90) at 6 months follow up to 90.3 (range 74-92) at final follow up.

CONCLUSION:

For the severe osteoporotic elderly with unstable fractures, bipolar hemiarthroplasty is an effective method to treat the unstable intertrochanteric fractures in the severe osteoporotic elderly. It can decrease complications, reduce mortality, improve the patient’s life quality, and reduce family burden. In Summation, when deciding on treatment methods for intertrochanteric fractures several factors must be considered, which are (included but not limited to) the type of fracture, the patient’s age, health status, severity of osteoporosis. As long as there was no absolute contraindication for surgery, it is appropriate to have surgery and to restore function as early as possible.