Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture
- Author:
Gashi YN
1
;
Elhadi AS
;
Elbushra IM
Author Information
- Publication Type:Journal Article
- Keywords: unstable; intertrochanteric fracture; bipolar hemiarthroplasty; DHS
- From:Malaysian Orthopaedic Journal 2018;12(1):36-41
- CountryMalaysia
- Language:English
- Abstract: Introduction: Although the treatment of choice for unstableintertrochanteric fractures in elderly patients has beeninternal fixation for a long time, several studies have shownmechanical and technical failures. Primary cemented bipolar(PCB) hemiarthroplasty has been proposed as an alternativewith some advantages concerning earlier mobilization andminimal postoperative complications.Materials and Methods: This is a prospective cohorthospital-based study conducted at three tertiary hospitalsover a period of two years. A total of 98 patients wereenrolled in the study, 38 patients treated with Dynamic HipScrew (DHS) and 60 patients treated with PCBhemiarthroplasty. Intraoperative events (e.g. duration ofsurgery and blood loss), hospital stay, weight bearing, HarrisHip score and post-operative complications were used aspredictors of final outcome. Mean follow-up was 13.66±5.9months in hemiarthroplasty group and 11.8±2.7 months atinternal fixation group.Results: The two groups were comparable in age, sex,comorbidity, mode of trauma, and classification of fracture.Early mobilisation was significantly better inhemiarthroplasty (p<0.001) where 93.3% of patients startedpartial weight bearing on postoperative Day 1, while in theDHS group, 73.7% of patients started partial weight bearingafter two weeks postoperatively. At the final follow-up, themortality rate did not differ between the two groups, butgeneral and mechanical complications were more commonin the DHS group. The mean Harris Hip score was better inthe hemiarthroplasty group (91.14 vs 74.11).Conclusion: Primary cemented bipolar hemiarthroplasty is asafe and valid option in treating unstable intertrochantericfracture. Although it has been shown to have someadvantages over DHS in certain circumstances, lack ofrandomization and difficulties in standardization of patientsand treating surgeon raise a need for more studies withbigger sample size and proper randomizatio
- Full text:16.2018my0402.pdf
