Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteic Fractures in the Elderly / 대한정형외과학회잡지

PURPOSE: To evaluate the positive effects and problems through clinical and radiological results of cementless bipolar hemiarthroplasty for intertrochanteric fractures above type A2 in the elderly. MATERIALS AND METHODS: From December 2006 to June 2009, 54 bipolar hemiarthroplasties were performed in 54 patients in our hospital. The mean age was 78.8 (67-93) years. Of these cases, 13 were male and 41 were female. The fractures were of type A2.1 in 17 cases, type A2.2 in 23 cases and type A2.3 in 14 cases. There was no walking limitation in 45 patients, but 4 of the remaining 9 patients had walking limitations and used walking aids at their residence. A posterolateral approach as well as cementless femoral stems was used in all the patients. Clinical results were evaluated according to operation time, amount of bleeding, time to resume walking, duration of hospital stay, recovery of walking ability, and complications. Prostheses loss was evaluated on the follow-up radiographs. RESULTS: Twenty-two of 39 patients who had medical co-morbidity had more than two medical co-morbidities. Operations were performed at a mean time of 5.5 days after the fracture. The mean operation time was 95 minutes. The average total amount of bleeding was of 715 cc. Patients began walking at an average of 5.9 days after operation and the average duration of hospital stay was 19.2 days. Sixteen patients (29.6%) died at an average period of 1.6 years after their operation. At the time of discharge, 32 patients (59%) had recovered walking ability, but at the last follow-up compared to the pre-injury status, the recovery rate of walking had decreased to 46% (25 patients). Complications included a deep infection in one case, dislocation in 2 cases and hematoma in 2 cases. The cause of revision was deep infection. There were no revisions due to prosthesis loosening. CONCLUSION: Cementless bipolar hemiarthroplasty for intertrochanteric fractures in the elderly had some problems due to the prolonged operation time and increased amount of bleeding, but it also had advantages including the early return to walking after the operation and decreased hospital stay. It is one of the treatment options for the elderly with unstable intertrochanteric fractures.

Cerebral Infraction after Cementless Total Hip Arthroplasty: A Case Report

A seventy-two year old male patient who had degenerative osteoarthritis due to acetabular dysplasia on the left hip joint was operated upon for cementless total hip arthroplasty. Sudden left hemiparesis developed on the day after the operation, so we immediately carried out brain computed tomography and magnetic resonance imaging. This showed multiple occlusions of the brain vessels at the right cerebral hemisphere. There was no arterial-venous shunt on the preoperative echocardiogram, yet the ultrasonogram of the right carotid artery showed over 70% postoperative stenosis. There was no evidence of pulmonary embolism on the chest computed tomography. We report here on a case of cerebral infarction that was caused by multiple microemboli after cementless total hip arthroplasty and we review the related medical literature.