Evaluation of cementless bipolar long stem hemiarthroplasty for geriatric intertrochanteric fracture at Viet Duc Hospital

Vu Truong Thinh, Tran Minh Long Trieu, Duong Ngoc Le Mai, Nguyen Xuan Thuy, Nguyen Van Thoan

Main Article Content

Abstract

Intertrochanteric fractures can result in high morbidity and mortality rates, especially in the
elderly. Surgeries are usually performed in order to help the patients access early mobility and
to limit the complications. In particular, the cementless bipolar long stem hemiarthroplasty has
shown many advantages. This study describes the clinical characteristics and evaluate the results
of cementless bipolar long stem hemiarthroplasty in 35 patients over 60 years of age who were
diagnosed with intertrochanteric fracture indicated to hemiarthroplasty at Viet Duc Hospital in the
period between January 2013 and January 2018. The average age of the patients was 83.9 ±
6.5, with the majority (65.7%) being 80 to 89 years old. The female/male ratio was 4/1. Chronic
disease was prevalent in 37.1% of the patients, of which 61% were cardiovascular diseases. Most
injuries were due to daily - life accidents (91.4%). Osteoporosis among all patients was grade II
or higher, with grade IV being most common (48.6%). These were all A2 fractures according to
the AO classification, and 91.4% had epiphyseal fit ≥ 90%. Postoperative complications accounted
for 8.7%. The mean Harris score for assessing rehabilitation outcomes was 84.54 ± 16.87.

Article Details

References

1. Fox KM, Magaziner J, Hebel JR, Kenzora JE, Kashner TM. Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment, and sequelae. J Gerontol A Biol Sci Med Sci. 1999;54(12):M635-640. doi: 10.1093/gerona/54.12.m635.
2. Cooper C, Cole ZA, Holroyd CR, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2011;22(5):1277-1288. doi: 10.1007/s00198-011-1601-6.
3. Muhr G, Tscherne H, Thomas R. Comminuted trochanteric femoral fractures in geriatric patients: the results of 231 cases treated with internal fixation and acrylic cement. Clin Orthop. 1979;(138):41-44.
4. Knobe M, Gradl G, Ladenburger A, Tarkin IS, Pape H-C. Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany? Clin Orthop. 2013;471(9):2831-2840. doi: 10.1007/s11999-013-2834-9.
5. Tu D, Liu Z, Yu Y, Xu C, Shi X. Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta-Analysis. Orthop Surg. 2020;12(4):1053-1064. doi: 10.1111/os.12736.
6. Fan L, Dang X, Wang K. Comparison between Bipolar Hemiarthroplasty and Total Hip Arthroplasty for Unstable Intertrochanteric Fractures in Elderly Osteoporotic Patients. PLOS ONE. 2012;7(6):e39531. doi: 10.1371/journal.pone.0039531.
7. Dung TT, Hieu ND, Son LM, Dinh TC, Dinh TC. Primary Cementless Bipolar Long Stem Hemiarthroplasty for Unstable Osteoporotic Intertrochanteric Fracture in the Elderly Patients. Open Access Maced J Med Sci. 2019;7(24):4342-4346. doi: 10.3889/oamjms. 2019.388.
8. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970;52(3):457-467.
9. Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Springer Science & Business Media; 2012.
10. Ackland MK, Bourne WB, Uhthoff HK. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg Br. 1986;68(3):409-413. doi: 10.13 02/0301-620X.68B3.3733807.
11. 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(4):737-755.
12. Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLOS Med. 2020;17(8):e1003180. doi: 10.1371/journal.pmed.1003180.
13. Adeyemi A, Delhougne G. Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JBJS Open Access. 2019;4(1):e0045. doi: 10.2106/JBJS.OA.18.00045.
14. Vũ Văn Khoa, Nguyễn Ngọc Hân. Đánh giá kết quả phẫu thuật thay khớp háng bán phần không cement điều trị gãy liên mấu chuyển xương đùi người cao tuổi tại bệnh viện Việt Đức năm 2017-2020. Tạp Chí Y Học Việt Nam. 2021;501(2). doi: 10.51298/vmj.v501i2.512.
15. Choi J-Y, Sung Y-B, Kim J-H. Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem. Hip Pelvis. 2016;28(4):208-216. doi: 10.5371/hp.20 16.28.4.208.
16. Võ Thành Toàn. Điều trị gãy liên mấu chuyển xương đùi ở bệnh nhân lớn tuổi bằng phẫu thuật thay khớp háng lưỡng cực chuôi dài tại bệnh viện Thống Nhất. Hội Nghị Thường Niên Lần Thứ XXII - Hội Nghị Chấn Thương Chỉnh Hình Thành Phố Hồ Chí Minh. 112-115.
17. 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. JBJS. 1989;71(8):1214-1225.
18. Lee Y-K, Ha Y-C, Chang B-K, Kim K-C, Kim T, Koo K-H. Cementless bipolar hemiarthroplasty using a hydroxyapatite-coated long stem for osteoporotic unstable intertrochanteric fractures. J Arthroplasty. 2011;26(4):626-632. doi: 10.1016/j.arth.2010.0 5.010.
19. Li Y, Lin J, Wang P, et al. Effect of time factors on the mortality in brittle hip fracture. J Orthop Surg. 2014;9:37. doi: 10.1186/1749-799X-9-37.
20. Fox KM, Magaziner J, Hawkes WG, et al. Loss of bone density and lean body mass after hip fracture. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2000;11(1):31-35. doi: 10.1007/s0 01980050003.
21. Kayali C, Agus H, Ozluk S, Sanli C. Treatment for Unstable Intertrochanteric Fractures in Elderly Patients: Internal Fixation versus Cone Hemiarthroplasty. J Orthop Surg. 2006;14(3):240-244. doi: 10.1177/2309499006 01400302.
22. Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop. 2001;(384): 189-197. doi: 10.1097/00003086-200103000-00022.