Faster return to weight bearing with hemiarthroplasty vs. internal fixation for unstable intertrochanteric fractures

Researchers found more early complications in patients treated with internal fixation, although the difference did not reach statistical significance.

Both internal fixation with dynamic hip screws and cone hemiarthroplasty yield similar functional results in patients with unstable intertrochanteric fractures, a study by researchers in Turkey found. However, patients treated with hemiarthroplasty had fewer postop complications and achieved weight bearing significantly earlier, the authors noted.

Cemil Kayali, MD, and colleagues at the Tepecik Education and Research Hospital in Izmir, Turkey, compared outcomes between the two treatments in patients aged at least 60 years. They published their results in the Journal of Orthopaedic Surgery.

The study included 42 patients treated with hemiarthroplasty involving a cone prosthesis between 2001 and 2003 at an average age of 73 years. The internal fixation group included 45 patients treated between 1999 and 2001 at an average age of 75 years.

The researchers found no significant differences between the two groups in terms of demographics, fracture type, preoperative Singh index, length of hospitalization and metabolic or associated diseases, the authors reported.

Surgeons performed hemiarthroplasty using a posterior Osborne incision with the patients in the lateral decubitus position. They inserted the femoral stem using a press-fit technique to improve osseointegration, they wrote, and did not remove the lesser trochanter.

Surgeons encouraged passive rehabilitation to begin on the first postop day while in the hospital bed, and allowed partial weight bearing throughout hospitalization.

Surgeons performed internal fixation using C-arm fluoroscopy with the patient in the supine position. These patients were also encouraged to perform rehabilitation activities while in the hospital bed.

Hospital discharge occurred at a mean 12 days postop for the internal fixation group and at mean 13 days postop for the hemiarthroplasty group, according to the study.

Patients in the hemiarthroplasty group achieved full weight bearing at an average of 4 weeks postop, significantly sooner than the mean 10 weeks postop for internal fixation patients (P<.0001), according to the study.

The internal fixation group also had more early complications, although the difference did not reach statistical significance. Both groups had similar rates of late complications as well as similar clinical results, the authors noted.

At 24 months mean follow-up among 32 surviving hemiarthroplasty patients, eight patients were deemed to have unsatisfactory results, eight had excellent results and 16 had good results, the authors reported.

No hemiarthroplasty patients showed dislocation, acetabular protrusion or aseptic stem loosening, and none underwent revision, they noted.

Follow-up averaged 29 months for the internal fixation group, with 38 surviving. At final follow-up, 12 patients had unsatisfactory clinical results, 11 had excellent results and 15 had good results, according to the study.

Six internal fixation patients with unsatisfactory results, caused by implant cut-out, underwent revision surgery — either arthroplasty or implant removal, the authors said.

For more information:
Kayali C, Agus H, Ozluk S, Sanli C. Treatment for unstable intertrochanteric fractures in elderly patients: internal fixation versus cone hemiarthroplasty. J Orthop Surg (Hong Kong). 2006;14:259240-244.