Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases

  • Ji-Hun Park (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Young-Yool Chung (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Sung-Nyun Baek (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Tae-Gue Park (Department of Orthopaedic Surgery, Kwangju Christian Hospital)
  • Received : 2022.01.11
  • Accepted : 2022.02.14
  • Published : 2022.06.30
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Abstract

Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3.03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion: Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

Keywords

References

  1. Park BJ, Cho HM, Min WB. A comparison of internal fixation and bipolar hemiarthroplasty for the treatment of reverse oblique intertrochanteric femoral fractures in elderly patients. Hip Pelvis. 2015;27:152-63. https://doi.org/10.5371/hp.2015.27.3.152
  2. Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res. 1987;(224):169-77.
  3. Lee YK, Ha YC, Chang BK, Kim KC, Kim TY, Koo KH. Cementless bipolar hemiarthroplasty using a hydroxyapatite-coated long stem for osteoporotic unstable intertrochanteric fractures. J Arthroplasty. 2011;26:626-32. https://doi.org/10.1016/j.arth.2010.05.010
  4. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72:26-31. https://doi.org/10.1302/0301-620X.72B1.2298790
  5. Haentjens P, Casteleyn PP, Opdecam P. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg. 1994;113:222-7. https://doi.org/10.1007/BF00441837
  6. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987;69:1335-40. https://doi.org/10.2106/00004623-198769090-00005
  7. Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty. 2005;20:337-43. https://doi.org/10.1016/j.arth.2004.04.017
  8. Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am. 2009;40:311-20. https://doi.org/10.1016/j.ocl.2009.02.007
  9. Yoo JI, Ha YC, Lim JY, Kang H, Yoon BH, Kim H. Early rehabilitation in elderly after arthroplasty versus internal fixation for unstable intertrochanteric fractures of femur: systematic review and meta-analysis. J Korean Med Sci. 2017;32:858-67. https://doi.org/10.3346/jkms.2017.32.5.858
  10. Sibia US, Turner TR, MacDonald JH, King PJ. The impact of surgical technique on patient reported outcome measures and early complications after total hip arthroplasty. J Arthroplasty. 2017;32:1171-5. https://doi.org/10.1016/j.arth.2016.10.031
  11. Kim MW, Chung YY, Lim SA, Shim SW. Selecting arthroplasty fixation approach based on greater trochanter fracture type in unstable intertrochanteric fractures. Hip Pelvis. 2019;31:144-9. https://doi.org/10.5371/hp.2019.31.3.144
  12. Malchau H, Karrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty. Digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418-24. https://doi.org/10.3109/17453679508995578
  13. Hwang DS, Jung HT, Kim SB, Kim JS. Recovery of walking ability after operation for unstable intertrochanteric fractures of the femur in elderly: timing on weight bearing. J Korean Soc Fract. 1998;11:296-303. https://doi.org/10.12671/jksf.1998.11.2.296
  14. Ceder L, Thorngren KG, Wallden B. Prognostic indicators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop Relat Res. 1980;(152):173-84.
  15. Stern MB, Angerman A. Comminuted intertrochanteric fractures treated with a Leinbach prosthesis. Clin Orthop Relat Res. 1987;(218):75-80.
  16. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000;(371):206-15.
  17. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780-5. https://doi.org/10.2106/00004623-200704000-00012
  18. Kim BH, Chung YY, Jun SH, Choi DH. Two-incision bipolar hemiarthroplasty for treating femoral neck fracture: analysis of 15 cases. J Korean Hip Soc. 2010;22:203-8. https://doi.org/10.5371/jkhs.2010.22.3.203
  19. Hamadouche M, Zniber B, Dumaine V, Kerboull M, Courpied JP. Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate. J Bone Joint Surg Am. 2003;85:1330-7. https://doi.org/10.2106/00004623-200307000-00020
  20. Park SE, Kim YY, Jeong JJ, Choi SG, Jeong DS, Kim WY. Comparison of postoperative bleeding and complications between cemented and non-cemented bipolar hemiarthroplasty in treatment of unstable pertrochanteric fracture. Hip Pelvis. 2013;25:37-43. https://doi.org/10.5371/hp.2013.25.1.37
  21. Yoo JH, Kim SM, Jung HJ, Hwang JH. Clinical outcomes of U-blade Gamma3 nails used to treat patients with trochanteric fractures: retrospective multicenter study. Hip Pelvis. 2019;31:95-101. https://doi.org/10.5371/hp.2019.31.2.95
  22. Barnett SL, Peters DJ, Hamilton WG, Ziran NM, Gorab RS, Matta JM. Is the anterior approach safe? Early complication rate associated with 5090 consecutive primary total hip arthroplasty procedures performed using the anterior approach. J Arthroplasty. 2016;31:2291-4. https://doi.org/10.1016/j.arth.2015.07.008
  23. Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469:503-7. https://doi.org/10.1007/s11999-010-1568-1