Role of primary bipolar arthroplasty or total hip arthroplasty - Punjab ...
Role of primary bipolar arthroplasty or total hip arthroplasty - Punjab ... 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. REFERENCES 1. Melton LJ, 3rd. Epidemiology of hip fractures: implications of the exponential increase with age. Bone 1996; 18:121s-125s. 2. Melton LJ, 3rd. Hip fractures: A worldwide problem today and tomorrow. Bone 1993; 14 Suppl 1: s1-8. 3. Alffram PA. An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population with special reference to etiologic factors. Acta Orthop Scand 1964; 65: 9-109. 4. Stern MB and goldstein TB. The use of leinbach prosthesis in intertrochantric fractures of hip. Clin Orthop 1977; 128; 325-9. 5. 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 Jun; 51(4):737-55. 6. Salvati EA, Wilson PD (1973) long term results of femoral head replacement. J Bone Joint Surg Am 55a:516-524 7. Parker M, Johansen A. Clinical review. Hip fracture. Bmj. 2006; 333: 27-30. 8. Kannus P, Parkkari J, Sievänen H, heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996 Jan; 18(1 Suppl): 57s-63s. 9. Davis TR, Sher JL, Horsman A et al (1990) intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26-31. 10. Mariani EM and Rand JA. Non-union of intertrochanteric fractures of femur following open reduction and internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Acta Orthop Belg 1994; 60 (1): 11-3... 11. Massie WK. Extra capsular fractures of the hip treated by impaction using sliding nail plate fixation. Clin Orthop 1962; 22:180. 12. Holt EP JR. Hip fractures of the trochanteric region; treatment with a strong nail and early weight bearing. J Bone Joint Surg 1963; 45:687. 13. Dimon JH. The unstable intertrochanteric fracture. Clin Orthop 1973; 92:100-107. 14. Davis TR, Sher JL, Horsman A et al (1990) intertrochanteric femoral Pb Journal of Orthopaedics Vol-XII, No.1, 2011 8 PDF created with pdfFactory Pro trial version www.pdffactory.com
Bipolar or total hip arthroplasty for intertrochanteric fracture fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26-31. 15. Kyle RF, Gustiolo RB, Premer RF. Analysis of six hundred and twenty two intertrochanteric hip fractures. A retrospective and prospective study. J Bone Joint Surg 1979; 61:219-221. 16. Hayward SJ, Lowe Lw, Tzeueleros S. Intertrochanteric fractures comparison between fixation with a two piece nail plate and enders nail. Int Orthop 1983; 7:153. 17. Kim WY, Han CH, park JI, Kim JY (2001) failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 25:360-362. 18. Laros GS and Mooore JF complications of fixation in joint fractures. Clin orthop 1947; 101: 110-9. 19. Chapman MW, Bowman WE, Csongradi JJ et al. The use of enders pins in extracapsular fractures of the hip. J Bone Joint Surg 1981; 65:14-28. 20. Mehlhoff T, Landon GC, Tullos HS. Total hip arthroplasty following failed internal fixation of hip fractures. Clin Orthop 1991; 269:32-37. 21. Zhang Q, Pang Q, Huang T, GE A, Tang T, Chen l. The clinical effect of bipolar long-stem prosthetic replacement on the treatment of comminuted intertrochanteric fracture of hip in the elderly osteoporotic patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2005 Mar; 19(3):198-200. 22. Van Loon CJ, De Wall Malefijt MC, Veth RP. Primary treatment of unstable pertrochantric femoral fracture using a head-neck prosthesis in elderly patients. Ned Tijdschr Geneeskd. 1994 Sept. 3; 138(36):1810-3. 23. Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty 2005 Apr; 20(3):337- 43. 24. Haentjens P, Casteleyn P, Deboeck H. Treatment of unstable intertrchanteric and subtrochanteric fractures in elderly patientsprimay bipolar arthroplasty compared with internal fixation. J Bone Joint Surg 1989; 71A:1214-25. 25. Haentjens P., G. Lamraski endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disability & rehabilitation Jan 2005, Vol. 27, No. 18-19:1167-1180. 26. Rodop O, Kiral A, Kaplan H, Akmaz I (2002) Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 26:233-237 27. F. Geiger, M. Zimmermann-stenzel, C. Heisel, B. Lehner, W. Daecke trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality Arch Orthop Trauma Surg (2007) 127:959-966 28. Haentjens P, Casteleyn PP, Opdecam P (1989) Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg 60(Suppl 1):124-128 Pb Journal of Orthopaedics Vol-XII, No.1, 2011 9 PDF created with pdfFactory Pro trial version www.pdffactory.com
- Page 1 and 2: Original Article Role of primary bi
- Page 3: Bipolar or total hip arthroplasty f
Bipolar <strong>or</strong> <strong>total</strong> <strong>hip</strong> <strong>arthroplasty</strong> f<strong>or</strong> intertrochanteric fracture<br />
fractures. Mechanical failure after internal fixation. J Bone Joint<br />
Surg Br 72:26-31.<br />
15. Kyle RF, Gustiolo RB, Premer RF. Analysis <strong>of</strong> six hundred and<br />
twenty two intertrochanteric <strong>hip</strong> fractures. A retrospective and<br />
prospective study. J Bone Joint Surg 1979; 61:219-221.<br />
16. Hayward SJ, Lowe Lw, Tzeueleros S. Intertrochanteric fractures<br />
comparison between fixation with a two piece nail plate and enders<br />
nail. Int Orthop 1983; 7:153.<br />
17. Kim WY, Han CH, park JI, Kim JY (2001) failure <strong>of</strong><br />
intertrochanteric fracture fixation with a dynamic <strong>hip</strong> screw in<br />
relation to pre-operative fracture stability and osteop<strong>or</strong>osis. Int<br />
Orthop 25:360-362.<br />
18. Laros GS and Moo<strong>or</strong>e JF complications <strong>of</strong> fixation in joint fractures.<br />
Clin <strong>or</strong>thop 1947; 101: 110-9.<br />
19. Chapman MW, Bowman WE, Csongradi JJ et al. The use <strong>of</strong> enders<br />
pins in extracapsular fractures <strong>of</strong> the <strong>hip</strong>. J Bone Joint Surg 1981;<br />
65:14-28.<br />
20. Mehlh<strong>of</strong>f T, Landon GC, Tullos HS. Total <strong>hip</strong> <strong>arthroplasty</strong><br />
following failed internal fixation <strong>of</strong> <strong>hip</strong> fractures. Clin Orthop<br />
1991; 269:32-37.<br />
21. Zhang Q, Pang Q, Huang T, GE A, Tang T, Chen l. The clinical<br />
effect <strong>of</strong> <strong>bipolar</strong> long-stem prosthetic replacement on the treatment<br />
<strong>of</strong> comminuted intertrochanteric fracture <strong>of</strong> <strong>hip</strong> in the elderly<br />
osteop<strong>or</strong>otic patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi<br />
2005 Mar; 19(3):198-200.<br />
22. Van Loon CJ, De Wall Malefijt MC, Veth RP. Primary treatment <strong>of</strong><br />
unstable pertrochantric fem<strong>or</strong>al fracture using a head-neck<br />
prosthesis in elderly patients. Ned Tijdschr Geneeskd. 1994 Sept.<br />
3; 138(36):1810-3.<br />
23. Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented <strong>hip</strong><br />
<strong>arthroplasty</strong> with a novel cerclage cable technique f<strong>or</strong> unstable<br />
intertrochanteric <strong>hip</strong> fractures. J Arthroplasty 2005 Apr; 20(3):337-<br />
43.<br />
24. Haentjens P, Casteleyn P, Deboeck H. Treatment <strong>of</strong> unstable<br />
intertrchanteric and subtrochanteric fractures in elderly patientsprimay<br />
<strong>bipolar</strong> <strong>arthroplasty</strong> compared with internal fixation.<br />
J Bone Joint Surg 1989; 71A:1214-25.<br />
25. Haentjens P., G. Lamraski endoprosthetic replacement <strong>of</strong> unstable,<br />
comminuted intertrochanteric fracture <strong>of</strong> the femur in the elderly,<br />
osteop<strong>or</strong>otic patient: a review. Disability & rehabilitation Jan 2005,<br />
Vol. 27, No. 18-19:1167-1180.<br />
26. Rodop O, Kiral A, Kaplan H, Akmaz I (2002) Primary <strong>bipolar</strong><br />
hemiprosthesis f<strong>or</strong> unstable intertrochanteric fractures. Int Orthop<br />
26:233-237<br />
27. F. Geiger, M. Zimmermann-stenzel, C. Heisel, B. Lehner, W. Daecke<br />
trochanteric fractures in the elderly: the influence <strong>of</strong> <strong>primary</strong> <strong>hip</strong><br />
<strong>arthroplasty</strong> on 1-year m<strong>or</strong>tality Arch Orthop Trauma Surg (2007)<br />
127:959-966<br />
28. Haentjens P, Casteleyn PP, Opdecam P (1989) Primary <strong>bipolar</strong><br />
<strong>arthroplasty</strong> <strong>or</strong> <strong>total</strong> <strong>hip</strong> <strong>arthroplasty</strong> f<strong>or</strong> the treatment <strong>of</strong> unstable<br />
intertrochanteric and subtrochanteric fractures in elderly patients.<br />
Acta Orthop Belg 60(Suppl 1):124-128<br />
Pb Journal <strong>of</strong> Orthopaedics Vol-XII, No.1, 2011<br />
9<br />
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