Outcome of Primary Cementless Hip arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys Su-Hyun Cho, MD., Hyung-Lae Cho, MD., Hong-Cho,

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Outcome of Primary Cementless Hip arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys Su-Hyun Cho, MD., Hyung-Lae Cho, MD., Hong-Cho, MD. Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea B A C D Introduction We report outcomes of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderly. Material and Method Patients Seventy-year-old man with unstable intertrochanteric fracture with communited femoral neck fracture who was treated with total hip arthroplasty. (A) Preoperative computed tomography, (B) preoperative X-ray, (C) postoperative X-ray, (D) postoperative X-ray in 9 months. Mar. 2009 – Feb. 2012 35 hip replacements (M/F = 14/21) Selection criteria 1. loss of medial support 2. age > 70 3. osteoporosis ( Singh index < 4) Two type of stem stem 1 ; monoblock stem 2 ; modular (Lima-Lto) Retrospective study operative time, transfusion amount, hospital stay time to full weight bearing. Clinical outcome Parker and Palmer (P&P) mobility score Harris hip score (HHS). Radiological outcome bone healing of fractured trochanter subsidence canal fill index stress shielding Posterior approach Primary stability ; inevitable Added stabiity by screw or wire Acetabular replacement > Tonnis grade, 1 > Acetabular index,10° Mann-Whitney U test A B C D Seventy-year-old woman with unstable intertrochanteric fracture treated with total hip arthroplasty. (A) Preoperative computed tomography, (B) preoperative X-ray, (C)postoperative X-ray, (D) postoperative X-ray in 13 months. Stem 1 Clinical outcome preinjury Last F/U P-value P&P score (mean) 7.1 6.5 >0.05 HHS (median) 81 75 Stem 2 Ambulatory status Preinjury Last F/U Community and household 26 (74%) 22 (63%) Nonfunctional and wheelchair-bound 9 (26%) 13 (37%) Operative technique Complications Infection ; nil stem subsidence ; nil Linear periprosthetic fracture ; 1 Dislocation of prosthetic head (THA) ; 1 Acetabular erosion developing to acetabular defect ; 1 Statistical analysis Primary stability was achieved with monoblock rectangular stem (A) or modular fluted long stem (B). Conclusion Results If carefully selected, cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderly in short term follow-up, but it is necessary to try to obviate rare complications such as postoperative dislocation or development of acetabular defect. Mean F/U ; 15 mon. (range, 12-34 mon.) Average op time; 92 min. (range,80-120 min.) Mean transfusion; 0.95 L (range,0.8-1.6 L) Mean hospital stay; 29 days (range, 17-38 days) Mean time to FWB; 47 days (range, 24-79 days) Key Words: Hip, Intertrochanteric femur fracutre, Hip replacement arthroplasty