Comparison of mortality rate between bipolar hemiarthroplasty and proximal femoral nail anti-rotation for intertrochanteric fractures in Sanglah hospital, Bali

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Result: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p=0.028). Bipolar hemiarthroplasty group also had longer length of stay (LoS) (50%) than the PFNA group (32.4%), albeit statistically insignificant (p=0.13). There was no significant difference between the 2-year mortality rate and LoS (p=0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2-year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher LoS than the PFNA group. Future prospective, multi-center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.

Comparison between the results of bipolar hemiarthroplasty with lateral approach and posterior approach in Sanglah General Hospital in 2018: a case series

The purpose of this study was to compare the preoperative, intraoperative and postoperative parameters of Bipolar Hemiarthroplasty procedure using lateral approach and posterior approach in Sanglah General Hospital in 2018. Thirty-five patients diagnosed with femoral neck fracture or intertrochanter fracture underwent Bipolar Hemiarthroplasty using either lateral approach or posterior approach at our institution between January 2018 and December 2018. The primary outcome measures were postoperative complication and hip function. The secondary outcome measures were surgical time, transfusion rate, length of hospital stay, intraoperative blood loss and postoperative haemoglobin. There were 14 patients in Lateral Approach group and 21 patients Posterior Approach group included for analysis. There were no significant differences between the two groups regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between Bipolar Hemiarthroplasty with Lateral Approach and Bipolar Hemiarthroplasty with Posterior Approach group in comparison of intraoperative blood loss (p<0.05) and length of stay (p<0.05). The present study concluded that both lateral and posterior approaches are comparable in terms of functional outcomes and complications. However, there is a tendency of longer hospital of length of stay and more of intraoperative blood loss using posterior approach which should be kept in mind when orthopaedic surgeon is performing a bipolar hemiarthroplasty.

Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.

Clinical Outcomes of Bipolar Hemiarthroplasty versus Total Hip Arthroplasty: Assessing the Potential Impact of Cement Use and Pre-Injury Activity Levels in Elderly Patients with Femoral Neck Fractures / 대한고관절학회지

PURPOSE: This study was performed to analyze the potential impact of cement use and favorable pre-injury activity on clinical outcomes of bipolar hemiarthroplasty (BHA) compared with total hip arthroplasty (THA) in elderly patients with femoral neck fractures. MATERIALS AND METHODS: Systematic review and meta-analysis of 12 clinical studies (5 randomized controlled trials and 7 comparative studies). Subgroup analysis was performed based on type of fixation method (cemented vs. cementless) and in the patient with independent ambulation, respectively. RESULTS: A significantly higher dislocation rate was observed in patients treated with THA compared with those treated with BHA in individuals capable of independent ambulation before injury (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.62; P=0.05, Z=1.98). Also, the dislocation rate was significantly higher in patients treated with cemented THA compared with those treated with cemented BHA (OR, 0.18; 95% CI, 0.05–0.62; P=0.006, Z=2.73). EQ-5D was significantly higher in those treated with cemented THA compared with patients treated with cemented BHA. Lastly, HHS was significantly higher in patients treated with cementless THA compared with those treated with cementless BHA. CONCLUSION: An increase in the dislocation rate was observed when THA was performed in elderly patients with femoral neck fracture and who were pre-injury independent walkers. In addition, cemented THA was associated with a higher dislocation rate compared with cemented BHA. However, the dislocation rate in those treated with cementless THA were similar to patients treated with cementless BHA. With regards to functional score, THA was superior to BHA in both cementless and cemented fixation.

Effects of Trunk Control Rehabilitation Robot Training on Dynamic Balance, Lower Extremity Strength, Gait Ability and Pain in Bipolar Hemiarthroplasty

PURPOSE: This study examined the effects of trunk control rehabilitation robot training (TCRRT) on the dynamic balance, lower extremity strength, gait ability and pain for bipolar hemiarthroplasty. METHODS: Hemiarthroplasty (n=28) patients participated in this study. The subjects were randomized into two groups: trunk control rehabilitation robot training group and control group. RESULTS: The TCRRT group showed significantly more improvement in the MFRT, MMT, 10MWT, TUG, and VAS compared to that before intervention (p<0.05). In addition, all tests were significantly greater in the experimental group than in the control group. CONCLUSION: These results suggest that TCRRT is feasible and effective for improving the dynamic balance, lower extremity strength, gait ability, and pain efficacy after bipolar hemiarthroplasty.

Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture

@#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

A Non-Randomized Prospective Study of Management of Intracapsular Fracture Neck of Femur with Bipolar Hemiarthroplasty.

Background: The fracture neck of femur is one of the commonest fractures in elderly. With life expectancy increasing with each decade, our society is becoming increasingly an active geriatric society, with significant number of hospitalized and nursing home patients with femoral neck fractures and their sequelae. Selection of the type of prosthesis is very important in hemiarthroplasty as different types are available. Since the last two decades, bipolar replacements of the femoral head have gained popularity for treating femoral neck fractures. Aim & Objective – To assess and analyse the results of management of fracture neck of femur with bipolar hemiarthroplasty. Methods: After obtaining ethical committee approval and informed consent from patient, detailed history of patient was taken with particular emphasize on mode of injury and associated medical illness. On the day of surgery , under anesthesia and patient in lateral position, following strict aseptic precautions, either lateral (Hardinge) or Posterior (Southern-Moore) approach incision made, tissues dissected, joint capsule incised and femoral head extracted with the help of cork screw. Then the appropriate size of prosthesis with cement was seated. The wound was closed meticulously in layers. Knee flexion, isotonic quadriceps exercises were started from 1st or 2nd post op day and patients were mobilized with walker as tolerated. Patients are educated on different position of legs that should be avoided in the postoperative period. Follow up was done after 6 weeks and for further at 3 months, 6 months & 1 year .Result: In our series, at the end of final follow-up, there was no evidence of loosening, radiolucent zones, distal migration or subsidence of prosthesis. The patient with Periprosthetic fracture healed and is weight bearing fully with no pain. One patient who had moderate heterotopic ossification had still has some mild pain occasionally. Conclusion: we conclude that bipolar hemiarthroplasty produces good functional outcomes with minimal complications for displaced intracapsular femoral neck fractures and has several advantages; these results are comparable to the other studies.

Capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the efficacy of capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.</p><p><b>METHODS</b>A retrospective study was designed. From June 2009 to June 2016, 53 senile patients (54 hips)with femoral neck fracture were treated operatively in Mianyang central hospital (Sichuan, China). There were 21 males and 32 females, ranging in age from 80 to 97.5 years old (mean, 84.7 years old). There were 11 hips of Garden type II, 26 hips of Garden type III and 17 hips of Garden type IV. All the patients underwent bipolar hemiarthroplasty with enhanced repair of hip capsular. The hip joint was opened by a T shaped incision over posterior capsule. The posterior hip capsular and short external rotators were repaired particularly after the bipolar prostheses were implanted. Surgical time, intra-operative blood loss, mean hospitalization time, deep venous thrombosis, mortality, hip dislocation, pain, periprosthetic fracture, and other complications were recorded. The functional outcome was evaluated using the Harris Hip Score at the last follow-up.</p><p><b>RESULTS</b>The 53 patients (54 hips) were evaluated during the hospitalization period and a mean follow-up period of 11.5 months(ranged, 3 to 36 months). No dislocation, incision infection and periprosthetic fracture appeared in this group. The mean surgical time was 65 minutes(ranged, 50 to 95 min). The mean intra-operative blood loss was 213 ml(ranged, 100 to 420 ml) and the mean hospitalization time was 13.3 days(ranged, 5 to 27 days). Two patients with deep vein thrombosis, one patient with pulmonary embolism and 10 patients with venous plexus thrombosis of calf muscle were diagnosed postoperatively. The rate of venous thrombosis was 24.53% (13/53). The patient with pulmonary embolism died 8 days after operation and the other 3 patients died from heart failure 4, 6 and 7 months after operation respectively. The mortality during first year after hemiarthroplasty was 7.55% (4/53). At the latest follow-up, 42 patients (43 hips)had no pain, 9 patients had mild pain, and 2 patients had moderate pain. No patients were non-ambulatory. The mean Harris Hip Score was 91.25±8.39, functional outcome was excellent in 44 hips, good in 5, and fair in 5.</p><p><b>CONCLUSIONS</b>The bipolar hemiarthroplasty with capsular-enhanced repair with suture anchors is effective in reducing postoperative complications of prosthesis dislocation.</p>

A Study of Management of Unstable Intertrochanteric Fractures and Basal Fractures of Neck of Femur in Elderly by Hemi-arthroplasty.

Background: Fractures of neck of femur are a major cause of morbidity and mortality in elderly population. Intertrochanteric fractures in elderly people are usually comminuted and unstable because of osteoporosis. Unstable intertrochanteric fractures in elderly patients are associated with high rates of morbidity and mortality2 although the results have improved with the use of Bipolar Hemi-Arthroplasty. Methods: All the patients were selected from among the admissions in the Department of Orthopaedics, MNR Medical college and hospital, Mediciti institute of medical sciences, Archana hospital, Hyderabad, from june 2013 to 2015 May. Cemented bipolar hemiarthroplasty (Non modular bipolar hip prosthesis of OSIM) with or without greater and lesser trochanter fixation by tension band wiring was done. The follow up was carried out at 6 weeks, 3 months, 6 months, and 1 year. The results were evaluated using Harris Hip Score Rating. Results: The average age of patients in our series was 65 years with a range of 60 years to 75 years. Out of 70 patients 42 (60%) were female and 28 (40%) male. Left side is more commonly involved with 38 patients (54%) than right side (46%). The average duration of hospital stay was 10 days, with a range of 10-25 days. Out of 70 patients 35 (50%) had excellent outcome, 14(20%), 14(20%), 7(10%), had good fair and poor outcomes respectively. Conclusion: Cemented bipolar hemi-arthroplasty with anatomical reconstruction of trochanteric region preserves abductor mechanism thus allowing early mobilization, safe early weight bearing on the injured hip and had a relatively low rate of complications.

Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem / 대한고관절학회지

PURPOSE: To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. MATERIALS AND METHODS: A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. RESULTS: The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. CONCLUSION: For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections.

Bipolar Hemiarthroplasty for Unstable Intertrochanteric Femur Fracture in Patients over the Age of 80 Years: Comparative Analysis between Cementless and Cemented Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the effectiveness of bipolar hemiarthroplasty for unstable intertrochanteric fracture in patients over the age of 80 years. MATERIALS AND METHODS: Sixty-two patients (62 cases) who had unstable comminuted intertrochanteric fractures between January 2007 and February 2012 were evaluated. All patients were over 80 years old at the time of the diagnosis, and were followed-up for at least 12 months. Patients were divided into two groups: those who received cementless stems (group 1, n=32) and those who received cemented stems (group 2, n=30). Functional results including Harris hip score, thigh pain, Koval's ambulatory classification, postoperative mortality rate, operation time, and the amount of blood loss were evaluated. RESULTS: The operation time and the amount of blood loss were significantly lower in group 1 compared to group 2. The Harris hip score was 82.1+/-8.6 points for group 1 and 83.4+/-7.5 points for group 2 at the final follow-up. One patient with poor cement press-fit level in group 2 experienced thigh pain. Twenty-seven patients (84.4%) in group 1 and 25 patients (83.3%) in group 2 recovered pre-injury ambulatory status. During the follow-up period, overall, 6 patients (18.8%) in group 1 and 8 patients (26.7%) in group 2 died. No significant differences in follow-up mortality rates were observed between the two groups. CONCLUSION: Considering the satisfactory clinical results, cementless bipolar hemiarthroplasty may be a good treatment option for patients over 80 years old with unstable intertrochanteric fracture.

Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23]) MATERIALS AND METHODS: We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening). RESULTS: There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000). CONCLUSION: There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH

Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture / 대한고관절학회지

PURPOSE: The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry. MATERIALS AND METHODS: Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis. RESULTS: At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C. CONCLUSION: Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture.

The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: The purpose of this study was to compare the outcomes of osteosynthesis using compression hip screw fixation versus bipolar hemiarthroplasty in AO type A2 intertrochanteric fractures. MATERIALS AND METHODS: From March 2003 to December 2009, 89 patients were included in this study. They were treated using compression hip screws (43 cases) or bipolar hemiarthroplasty (46 cases). The mean age of patients was 77.7 years (65-94 years) and the mean follow-up period was 5.9 years (1-8.3 years). For comparison of the outcomes in the two groups, statistical analyses were performed with parameters including anesthesia time, operation time, amount of transfusion, hospital stay, general complications, clinical outcome, time of partial weight-bearing using a walker, and radiological failure rate. RESULTS: Differences in the amount of transfusion, general complications, and clinical outcome (Merle d'Aubigne and Postel score) were not statistically significant between the two groups. The bipolar hemiarthroplasty group showed better results than the compression hip screw group for anesthesia time and the time of partial weight-bearing using a walker. Radiological failures were observed in hips in one case (2.2%) of bipolar hemiarthroplasty, and in four cases (9.3%) of compression hip screw fixation. CONCLUSION: Among elderly individuals with AO type A2 intertrochanteric fractures, patients treated with bipolar hemiarthroplasty were able to perform early ambulation. However, no significant difference in operation time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between the bipolar hemiarthroplasty and compression hip screw fixation groups.

Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture / 대한고관절학회지

PURPOSE: In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. MATERIALS AND METHODS: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. RESULTS: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. CONCLUSION: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Unstable Intertrochanteric Femoral Fracture in Elderly Patients / 대한고관절학회지

PURPOSE: The purpose of this study is to evaluate the results of bipolar hemiarthroplasty using calcar replacement stem for comminuted intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: Between March 1998 and March 2008, the clinical records of 79 cases who were older than 75 years of age and underwent bipolar hemiarthroplaty, using calcar replacement stem with figure of eight and cerclage wiring, were reviewed. Their mean age was 82.4 years(75-92 years) and the mean follow-up period was 68 months(24-92 months). RESULTS: The mean postoperative Harris hip score was 82.1(62-92), and preoperative walking ability was recovered in 56 cases(71%). Bony ingrowth fixation was achieved in 70 cases(89%), and fibrous stable fixation was in 9 cases(11%). Stress shields were revealed in 21 cases(27%). Nonunion of trochanter was found in 3 cases(4%), and wire fixation breakages were in 3 cases after bony union. The mean duration of bony union was 16.3 weeks(12-38 weeks). Aseptic loosening was observed in 1 case and protrusio acetabuli were in 2 cases. CONCLUSION: The result of clinical and radiological evaluations of bipolar hemiarthroplasty, using calcar replacement stem with figure of eight and cerclage wiring, were satisfactory in elderly patients with comminuted intertrochanteric fracture.

The Analysis of Postoperative Mortality after Bipolar Hemiarthroplasty for Hip Fractures in the Elderly / 대한고관절학회지

PURPOSE: This study evaluated the rate of mortality and analyzed the associated risk factors in elderly patients treated with bipolar hemiarthroplaty for the hip fractures. MATERIALS AND METHODS: Between March 1994 and March 2010, the clinical records of 246 patients(278 cases) older than 75 years of age who underwent bipolar hemiarthroplaty after hip fractures were reviewed. The mean age of the subjects was 83.7 years(75-103 years). The relationship between the postoperative one year mortality and the related factors (age, gender, type of hip fractures, the timing of surgery, the associated medical condition, ASA grade, osteoporosis, walking ability and residence type) were analyzed. The subjects were divided into the dead group and survivor group. RESULTS: The mean postoperative mortality rate within 1 year was 17.2%(48 cases). The highest mortality rate was observed at postoperative 3 months(9.7%, 27 cases), followed in order by between 4 and 6 months(5.4%, 15 cases) and 7 and 12 months(2.1%, 6 cases). The postoperative mortality rate within 1 year was affected by the timing of the operation, ASA grade, patient's walking ability, and residence type, but there were no significant difference of the other factors, such as age, gender, osteoporosis, and type of hip fractures. CONCLUSION: The ASA grade, timing of the operation, walking ability, and residence type are factors associated with the mortality rate in elderly patients with hip fractures.

Perioperative Blood Loss in Bipolar Hemiarthroplasty for Femoral Neck Fracture: Analysis of Risk Factors / 대한고관절학회지

PURPOSE: We compared visible blood loss and calculated blood loss after bipolar hemiarthroplasty in femoral neck fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS: A total of 356 patients who underwent bipolar hemiarthroplasty in femoral neck fracture between 2004 and 2010 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score, use of cement, and use of antithrombotic agents. RESULTS: Total calculated blood loss(1,408+/-72 ml) differed significantly from visible blood loss(980+/-102 ml). In addition, calculated blood loss differed between risk factors(1,526+/-369 ml in cardiovascular disease, 1,588+/-279 ml in general anesthesia, 1,645+/-920 ml in obesity, and 1,605+/-439 ml in use of antithrombotic agents). CONCLUSION: Total calculated blood loss was much greater than visible blood loss. Patients with risk factors such as cardiovascular disease, obesity, use of antithrombotic agents, and general anesthesia should be treated with care in order to reduce blood loss.

Hip Arthroplasty Using Collarless Polished Tapered Stem: Minimum 2 Years Follow-up Results

PURPOSE: This study evaluated the clinical and radiologic results of total hip arthroplasty and bipolar hemiarthroplasty using collarless polished tapered femoral stem. MATERIALS AND METHODS: We retrospectively reviewed the results of 33 patients who underwent THA and BHA using cemented CPT femoral stem from November 2006 to April 2009. The mean follow-up period was 33 months. The clinical results were evaluated with a Harris Hip Score (HSS), and radiographic results were assessed with cement grade, osteolysis, loosening, stress shielding and subsidence methods. RESULTS: Mean HSS improved with 91 points. Postoperative cement grade was A in 14 cases, B in 14 cases, C1 in 5 cases and D in none. Aseptic loosening was not found, while focal radiolucency in zone 8 was found. 70% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Subsidence of the femoral stem was less than 1 mm in 32 cases, and was 1.47 mm in another case. Ectopic ossification was observed in 13 cases, class I in 11 cases, and class II in 2 cases, using Brooker's classification. CONCLUSION: This study showed the good clinical and radiographic results of THA and BHA with a cemented CPT femoral stem at the mid-term follow-up. However, a long-term follow-up study will be needed to evaluate the more precise clinical and radiographic outcomes.

Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients

PURPOSE: This study was performed to compare the clinical results and complications of bipolar hemiarthroplasty and internal fixation using proximal femur nail antirotation (PFNA) for unstable elderly femoral intertrochanteric fractures. MATERIALS AND METHODS: From May 2008 to September 2010, 74 patients older than 65 years who underwent bipolar hemiarthroplasty(33 patients) or PFNA(41 patients) and followed for more than 1 year after surgery were enrolled in this study. The mean blood loss during operation, mean operation time, radiological results, clinical results, and complications were analyzed by the Student t-test and Chi-square test to compare the two groups. RESULTS: The volume of blood loss during the operation was statistically lesser in the PFNA group (P<0.05) and operation time was not statistically different between the two groups (p=0.73). The bipolar hemiarthroplasty group showed a statistically better outcome than the PFNA group in the beginning of weight bearing (p<0.05), the hospital stay (p<0.05). The degradations of Koval score and modified Harris hip score of the bipolar hemiarthroplasty group were statistically better than those of the PFNA group (p=0.03, p=0.02). The bipolar hemiarthroplasty group showed a statistically lower incidence of mechanical(9.1%, p=0.01) and general(12.1%, p=0.00) complications than the PFNA group. CONCLUSION: In elderly patients, bipolar hemiarthroplasty is thought to be one of the effective treatments for unstable femoral intertrochanteric fracutures when considering complications and clinical outcomes.