Role of primary bipolar arthroplasty or total hip arthroplasty - Punjab ...

Walia et al
Reoperation rates have been reported as high as 8-16%
with internal fixation in intertrochanteric fractures 17,18 .
Furthermore, repeat surgery in these patients carries with it a
high incidence of medical complications and post operative
dislocation of the prosthesis has also been shown to be
somewhat more common 19 .
From the above review of literature, it is evident that
although the use of internal fixation has decreased the mortality
rate, the rate of complication still ranges from 4-50% 16 and
walking with full weight bearing before the fracture has healed
is often impossible.
There is no doubt that the general consensus would be to
use internal fixation devices in stable intertrochanteric fractures
in younger patients as they can tolerate immobilization and if
needed, reoperation, quite well. However this is not so in elderly,
debilitated patients who sustain an unstable intertrochanteric
fracture.
Primary arthroplasty has been advocated in elderly patients
with a view to make the rehabilitation early and to lessen the
incidence of complications of prolonged immobilization which
are frequently encountered in the treatment with various forms
of internal fixation devices e.g. venous thrombosis, pulmonary
embolism, atelactasis and allied complications. The major
advantage of treatment with cemented endoprosthesis is the
early weight bearing and the rehabilitation of these elderly
patients to their pre-fractures level more quickly than is achieved
with various fixation devices.
Multiple studies 20,21,22 showed that unstable three or four
part hip fractures can be treated with a standard femoral stem
prosthesis and circlage wiring of the trochanters. This technique
allows safe early weight bearing on the injured hip and had a
relatively low rate of complications.
A major complication associated with arthroplasty is high
rate of dislocation 23 . Associated with the dislocations was a
much higher incidence of pressure sores and pulmonary
complications 24 . But use of bipolar arthroplasty instead of
total hip replacements can reduce this complication to an
acceptable rate 25 . Haentjens et al 26 and Geiger et al 27 separately
reported results of arthroplasty in intertrochanteric fractures.
In their studies dislocation rate in the patient group who
underwent total hip arthroplasty was significantly higher
(12% to 44.5%) than those who had bipolar arthroplasty
(0 to 3.3%).
In our study, there was no significant difference between
two forms of arthroplasty (bipolar hemi-replacement or total
hip replacement) in terms of hospital stay, time period required
for partial or complete weight bearing, and functional
results.
Though total hip arthroplasty appears to provide slightly
better results regarding pain and mobility;however, its
instability in addition to impaired reflexes, cognitive impairment,
and weaker musculature in elderly patients shows higher
dislocation rates (8%). This leads to increased hospital stay or
revision surgery. This complication was not seen with bipolar
hemi-arthroplasty.
So we are of opinion that although at the outset, it may
appear that the results are equally good in both the groups, in
elderly patients choice should fall for bipolar hemi-arthroplasty
than for Total hip replacement.
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