Bipolar prosthesis in elderly patients with unstable intertrochanteric hip fractures. Functional outcomes and reoperation rate after the first 100 cases
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Published:
Nov 18, 2020
Keywords:
elderly patients, intertrochanteric hip fracture, bipolar prosthesis, hemiarthroplasty, functional outcomes, reoperation
Main Article Content
Abstract
Introduction: The purpose of this retrospective study was to evaluate the functional outcomes, complications, and reoperations for the treatment of unstable intertrochanteric hip fractures by bipolar hip arthroplasty in elderly patients. Materials and Methods: We analyzed >70-year-old patients with unstable intertrochanteric hip fractures undergoing surgery between 2002 and 2013. Fractures were classified according to the OTA/AO classification. The analysis included length of hospital stay (LOS), Charlson comorbidity index (CCI), time to weight-bearing, need for weight-bearing assistance, all complications related to the procedure, and the reoperations rate. Results: Study population consisted of 100 patients (84 females, 16 males), with 101 fractures. Average age was 82.4 years (range, 72-102 years). Fractures were categorized as A2.2 in 59 cases and A2.3 in 42 cases. The average CCI was 6.23 (range, 4-9). The average LOS was 6.95 days (range, 5-18). Weight-bearing ambulation started on postoperative day 2 in 87,12% of cases. The average Harris hip score (HHS) was 84.7 (range, 69-92). The average follow-up period was 28.4 months (range, 12-40). There were 7 (6.93%) complications: 2 (1.98%) deep venous thrombosis, 1 (0.99%) pulmonary thromboembolism, 3 (2.97%) periprosthetic infections and 1 (0.99%) dislocation. The reoperation rate was 2.97%. Complications were significantly related to age (P=0.005) and to ICC (odds ratio [OR]: 2.8071; 95% confidence interval [CI]: 1.4105-5.58669). Conclusions: Bipolar prostheses allowed for early rehabilitationwith acceptable functional outcomes, associated with a low complication rate (6,93%) and a low reoperation rate (2,97%).
Level of Evidence: IV
Level of Evidence: IV
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How to Cite
Pesciallo, C., Garabano, G., Lopreite, F., Viale, G., Vedoya, S., & del Sel, H. (2020). Bipolar prosthesis in elderly patients with unstable intertrochanteric hip fractures. Functional outcomes and reoperation rate after the first 100 cases. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(4), 317-324. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1107
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Clinical Research
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References
1. Peeters Ch MM, Visser E, Van de Ree C, Gosens T, Den Oudsten BL, Vries J. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47(7):1369-82. https://doi.org/10.1016/j.injury.2016.04.018
2. Sidhu AS, Singh AP, Singh Ap, Singh S. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. Int Orthop 2010;34:789-92. https://doi.org/10.1007/s00264-009-0826-x
3. Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 2001;25(6):360-2.
https://doi.org/10.1007/s002640100287
4. Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: An evidencebased review of the literature. II: Intertrochanteric fractures. J Am Acad Orthop Surg 2008;16:665-73. https://doi.org/10.5435/00124635-200810000-00005
5. Yoo Jun-II, Ha Yong-Chan, Lim Jae-young, Kang Hyun, Yoon Byung-Ho, Kim Hyunho. Early rehabilitation in elderly after arthroplasty versus internal fixation for unstable intertrochanteric fractures of femur: a systematic review and meta-analysis. J Korean Med Sci 2017;32:858-67. https://doi.org/10.3346/jkms.2017.32.5.858
6. Broos PLO, Fourneau I. Intertrochanteric fractures: internal fixation or prosthetic replacement. Acta Orthop Belgica 2000;66(1):34-40. http://www.actaorthopaedica.be/archive/volume-66/issue-1/article/intertrochanteric-fractures-internal-fixation-or-prosthetic-replacement/
7. Rottela SK, Guru PS, K Harsha V, Harshavardhan R. Comparative study between proximal femoral nail and bipolar prosthesis in intertrochanteric fractures of the femur. Int J Orthop Sci 2018;4(1):708-13. https://doi.org/10.22271/ortho.2018.v4.i1k.102
8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-40. PMID: 5783851
9. Jameson SS, Khan SK, Baker P, James A, Gray A, Reed MR, Deehan DJ. A national analysis of complications following hemiarthropasty for hip fracture in older patients. Ann Int J Med 2012;105(5):455-60. https://doi.org/10.1093/qjmed/hcs004
10. Iglesias SL, Gentile L, Vanoli F, Mangupli MM, Pioli I, Riikka EK, et al. Femoral neck fractures in the elderly: from risk factors to prognostic features for survival. J Trauma Crit Care 2017;1(1):16-21. https://www.alliedacademies.org/articles/femoral-neck-fractures-in-the-elderly-from-risk-factors-to-pronostic-features-for-survival.html
11. Elmorsy A, Saied M, Allah AA, Zaied M, Hafez M. Primary bipolar arthroplasty in unstable intertrochanteric fractures in elderly. J Orthop 2012;2:13-7. https://doi.org/10.4236/ojo.2012.21003
12. Butler M, Forte M, Joglekar SB, Swiontkowski MF, Kane RL. Evidence Summary: Systematic review of surgical treatments for geriatric hip fractures. J Bone Joint Surg Am 2011;93:1104-15. https://doi.org/10.2106/JBJS.J.00296
13. Naik LG, Badgire KS, Sharma GM, Qureshi F. Treatment of unstable intertrochanteric fractures with cemented bipolar prosthesis. A prospective study. Indian J Orthop Surg 2017;3(1):27-30. https://doi.org/10.18231/2395-1362.2017.0006
14. Mukherjee J, Ganguli R. Clinical outcome of primary cemented hemiarthroplasty in unstable trochanteric fractures in elderly patients. Int J Res Orthop 2018;4(4):543-6. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182032
15. Engin ED, Yunus I, Murat E, Ozlem A. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med 2015;38(2):E63-E72. https://doi.org/10.25011/cim.v38i1.22577
16. Fichman SG, Makinen TJ, Safir O, Vincent A, Lozano B, Kashigar A, et al. Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rates as compared to cephalomedullary nailing. Int Orthop 2016;40(1):15-20. https://doi.org/10.1007/s00264-015-2794-7
17. Ozkayin N, Okcu G, Aktuglu K. Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical study. Injury 2015;46(Suppl 2):s3-8. https://doi.org/10.1016/j.injury.2015.05.024
18. Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. J Clin Orthop Trauma 2019;10(2):296-301. https://doi.org/10.1016/j.jcot.2017.09.015
2. Sidhu AS, Singh AP, Singh Ap, Singh S. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. Int Orthop 2010;34:789-92. https://doi.org/10.1007/s00264-009-0826-x
3. Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 2001;25(6):360-2.
https://doi.org/10.1007/s002640100287
4. Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: An evidencebased review of the literature. II: Intertrochanteric fractures. J Am Acad Orthop Surg 2008;16:665-73. https://doi.org/10.5435/00124635-200810000-00005
5. Yoo Jun-II, Ha Yong-Chan, Lim Jae-young, Kang Hyun, Yoon Byung-Ho, Kim Hyunho. Early rehabilitation in elderly after arthroplasty versus internal fixation for unstable intertrochanteric fractures of femur: a systematic review and meta-analysis. J Korean Med Sci 2017;32:858-67. https://doi.org/10.3346/jkms.2017.32.5.858
6. Broos PLO, Fourneau I. Intertrochanteric fractures: internal fixation or prosthetic replacement. Acta Orthop Belgica 2000;66(1):34-40. http://www.actaorthopaedica.be/archive/volume-66/issue-1/article/intertrochanteric-fractures-internal-fixation-or-prosthetic-replacement/
7. Rottela SK, Guru PS, K Harsha V, Harshavardhan R. Comparative study between proximal femoral nail and bipolar prosthesis in intertrochanteric fractures of the femur. Int J Orthop Sci 2018;4(1):708-13. https://doi.org/10.22271/ortho.2018.v4.i1k.102
8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-40. PMID: 5783851
9. Jameson SS, Khan SK, Baker P, James A, Gray A, Reed MR, Deehan DJ. A national analysis of complications following hemiarthropasty for hip fracture in older patients. Ann Int J Med 2012;105(5):455-60. https://doi.org/10.1093/qjmed/hcs004
10. Iglesias SL, Gentile L, Vanoli F, Mangupli MM, Pioli I, Riikka EK, et al. Femoral neck fractures in the elderly: from risk factors to prognostic features for survival. J Trauma Crit Care 2017;1(1):16-21. https://www.alliedacademies.org/articles/femoral-neck-fractures-in-the-elderly-from-risk-factors-to-pronostic-features-for-survival.html
11. Elmorsy A, Saied M, Allah AA, Zaied M, Hafez M. Primary bipolar arthroplasty in unstable intertrochanteric fractures in elderly. J Orthop 2012;2:13-7. https://doi.org/10.4236/ojo.2012.21003
12. Butler M, Forte M, Joglekar SB, Swiontkowski MF, Kane RL. Evidence Summary: Systematic review of surgical treatments for geriatric hip fractures. J Bone Joint Surg Am 2011;93:1104-15. https://doi.org/10.2106/JBJS.J.00296
13. Naik LG, Badgire KS, Sharma GM, Qureshi F. Treatment of unstable intertrochanteric fractures with cemented bipolar prosthesis. A prospective study. Indian J Orthop Surg 2017;3(1):27-30. https://doi.org/10.18231/2395-1362.2017.0006
14. Mukherjee J, Ganguli R. Clinical outcome of primary cemented hemiarthroplasty in unstable trochanteric fractures in elderly patients. Int J Res Orthop 2018;4(4):543-6. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182032
15. Engin ED, Yunus I, Murat E, Ozlem A. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med 2015;38(2):E63-E72. https://doi.org/10.25011/cim.v38i1.22577
16. Fichman SG, Makinen TJ, Safir O, Vincent A, Lozano B, Kashigar A, et al. Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rates as compared to cephalomedullary nailing. Int Orthop 2016;40(1):15-20. https://doi.org/10.1007/s00264-015-2794-7
17. Ozkayin N, Okcu G, Aktuglu K. Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical study. Injury 2015;46(Suppl 2):s3-8. https://doi.org/10.1016/j.injury.2015.05.024
18. Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. J Clin Orthop Trauma 2019;10(2):296-301. https://doi.org/10.1016/j.jcot.2017.09.015