J Korean Orthop Assoc.  2012 Apr;47(2):79-85. 10.4055/jkoa.2012.47.2.79.

Bipolar Hemiarthroplasty with Cementless Femoral Stem for Unstable Intertrochanteric Fractures

• Lee JM
• Nam HT
• Lee SH

• KMID: 2185382
• DOI: http://doi.org/10.4055/jkoa.2012.47.2.79

Abstract

PURPOSE
The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cementless femoral stem for treating unstable intertrochanteric fractures in elderly patients.
MATERIALS AND METHODS
This study included 41 hips of 41 patients who were followed up for over 2 years after bipolar hemiarthroplasty using cementless femoral stem between October 2006 and November 2008. The mean follow-up period was 33 months (24-42 months).
RESULTS
At the last follow-up, the mean Harris hip score was 81.3 points. All stems were stable without significant changes in alignment or progressive subsidence. There were no cases of leg length discrepancy over 5 mm. There were 3 cases of wire fixation breakage and 1 case of posterior hip dislocation.
CONCLUSION
The short-term results over 2 years of clinical and radiological evaluation of cementless bipolar hemiarthroplasty and wire fixation were satisfactory in elderly patients with unstable intertrochanteric fracture.

Keyword

unstable intertrochanteric fracture of femur; cementless femoral stem; wire fixation

MeSH Terms

Aged
Follow-Up Studies
Hemiarthroplasty
Hip
Hip Fractures
Humans
Leg

Figure

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  Figure 1 Candy package wiring technique. (A) Schematic drawing of candy package wiring. (B) The postoperative radiograph shows a good wiring fixation.

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  Figure 2 Anteriorposterior radiographs of the hip. (A) A 83-year-old woman patient had an unstable intertrochanteric fracture. (B) The postoperative radiograph shows a good proximal canal fit and wiring. (C) At postoperative 24 months, the radiograph shows stable fixation of the femoral stem.

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  Figure 3 Anteriorposterior radiographs of the hip. (A) A 80-year-old woman patient had an unstable intertrochanteric fracture. (B) The postoperative radiograph shows a good proximal canal fit and wiring. (C) At postoperative 30 months, the radiograph shows stable fixation of the femoral stem.

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  Figure 4 Coren® (Bencox®, Corentec, Seoul, Korea) cementless femoral stem. (A) Femoral component has a tapered wedge shape. (B) Femoral component has 3 vertical ribs.

Reference

1. Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res. 2004. 19:532–536.

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. 224:169–177.

3. Laros GS, Moore JF. Complications of fixation in intertrochanteric fractures. Clin Orthop Relat Res. 1974. 101:110–119.

4. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002. 84:372–381.

5. Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil. 2005. 27:1167–1180.

6. Rothman RH, Cohn JC. Cemented versus cementless total hip arthroplasty. A critical review. Clin Orthop Relat Res. 1990. 254:153–169.

7. Dandy DJ. Fat embolism following prosthetic replacement of the femoral head. Injury. 1971. 3:85–88.

8. Lee JM, Lee JH, Lee CW, Kim HM. New wiring method for lesser trochanter fixation in unstable intertrochanteric fractures: technical note. J Korean Fract Soc. 2005. 18:209–212.

9. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979. 61:216–221.

10. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969. 51:737–755.

11. Clawson DK. Intertrochanteric fracture of the hip. Am J Surg. 1957. 93:580–587.

12. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979. 141:17–27.

13. Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA. Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br. 1998. 80:585–590.

14. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990. 257:107–128.

15. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973. 55:1629–1632.

16. Hochberg MC, Williamson J, Skinner EA, Guralnik J, Kasper JD, Fried LP. Th e prevalence and impact of self-reported hip fracture in elderly community-dwelling women: the Women's Health and Aging Study. Osteoporos Int. 1998. 8:385–389.

17. Beckenbaugh RD, Ilstrup DM. Total hip arthroplasty. J Bone Joint Surg Am. 1978. 60:306–313.

18. Hwang DS, Lee KJ, Choi JH. Recovery of walking ability after treatment of unstable intertrochanteric fractures in elderly patients-comparison of compression hip screw to primary hemiarthroplasty. J Korean Soc Fract. 1999. 11:22–29.

19. Bendo JA, Weiner LS, Strauss E, Yang E. Collapse of intertrochanteric hip fractures fixed with sliding screws. Orthop Rev. 1994. Suppl. 30–37.

20. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000. 371:206–215.

21. Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989. 71:1214–1225.

22. Hwang DS, Lee CH, Hong CH, Kim KK, Joo YB. Operative treatment for the unstable femur intertrochanteric fracture in the elderly. J Korean Hip Soc. 2005. 17:156–163.

23. Yoon US, Kim GU, Kim YH, et al. Unstable intertrochanteric fractures treated by bipolar hemiarthroplasty. J Korean Hip Soc. 2000. 12:211–220.

24. Andress HJ, Kahl S, Kranz C, Gierer P, Schürmann M, Lob G. Clinical and finite element analysis of a modular femoral prosthesis consisting of a head and stem component in the treatment of pertrochanteric fractures. J Orthop Trauma. 2000. 14:546–553.

25. Park YS, Kim YS, Lee JM, Sun DH, Moon YW, Lim SJ. Cementless total Hip arthroplasty with use of the COREN hip system. J Korean Hip Soc. 2007. 19:457–462.

26. Jones JB. Screw fixation of the lesser trochanteric fragment. Clin Orthop Relat Res. 1977. 123:107.