Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians

Yıl 2014, Cilt: 48 Sayı: 4, 424 - 430, 03.09.2014

Yeesuk Kim Jun-Ki Moon Kyu-Tae Hwang Il-Yong Choi Young-Ho Kim

Öz

Objective: The aim of this study was to evaluate the clinical and radiographic outcomes of bipolar hemiarthroplasty with cementless stem for the unstable intertrochanteric fracture in octogenarians and to determine the influencing factors associated with subsidence of the stem.

Methods: The study included the 143 hips of 139 patients (119 females, 20 males). Mean follow-up period was 3.8 (range: 2.2 to 9.0) years. The displaced lesser trochanteric fragment was reduced anatomically and fixed with 16-gauge stainless steel cerclage wire. Clinical outcomes included Harris Hip Score (HHS), thigh pain, groin pain and walking ability. Radiographic outcomes included stem fixation and stability, osteolysis, heterotopic ossification and subsidence. The stable reduction group was determined when anatomic reduction of posteromedial fragments was achieved with ≤1 mm gap of fragment.

Results: Mean HHS was 82 (range: 78 to 99) at the final follow-up. Thirty-one hips (21.7%) experienced thigh pain and 19 (13.3%) groin pain. One hundred and twelve patients (80.6%) regained their pre-injury level of ambulation. All femoral stems showed osseointegration without aseptic loosening and osteolysis. The mean stem subsidence was 3.1±2.4 (range: 0 to 18) mm. The extent of subsidence was significantly higher in patients with unstable reduction. The survival rate was 94.2%.

Conclusion: Cementless bipolar hemiarthroplasty appears to be a suitable method for the treatment of intertrochanteric fracture in octogenarians. However, stable fixation of the posteromedial fragment is necessary to avoid stem subsidence.

Anahtar Kelimeler

Hemiarthroplasty; intertrochanteric fracture; octogenarians; osteoporosis.

Sekizinci dekatta bulunan hastalarda instabil intertrokanterik kırıkların tedavisinde sementsiz bipolar hemiartroplasti

Öz

Amaç: Bu çalışmanın amacı, sekizinci dekatta bulunan hastalarda instabil intertrokanterik kırıklar için sementsiz stem ile bipolar hemiartoplastinin klinik ve radyografik sonuçlarını değerlendirmek ve stemin çökmesi ile ilişkilendirilen etmenleri belirlemek idi.

Çalışma planı: Çalışmaya 139 (119 kadın, 20 erkek) hastaya ait 143 kalça dahil edildi. Ortalama takip süresi 3.8 (dağılım: 2.2-9.0) yıl idi. Deplase küçük trokanterik fragmana anatomik redüksiyon uygulandı ve fragman 16 numara paslanmaz çelik serklaj teli ile tespit edildi. Klinik sonuçlar, Harris Kalça Skoru (HKS), uyluk ağrısı, kasık ağrısı ve yürüme kabiliyetini; radyografik sonuçlar stem tespiti ve stabilitesi, osteoliz, heterotopik ossifikasyon ve çökmeyi ortaya koydu. Posteromedial fragmanların anatomik redüksiyonu 1 mm veya daha az fragman boşluğu ile gerçekleştirilen hastalar stabil redüksiyon grubu olarak kabul edildi.

Bulgular: Son kontrolde ortalama HKS 82 (dağılım: 78-99) idi. Otuz bir kalçada (%21.7) uyluk ağrısı, 19 kalçada (%13.3) kasık ağrısı mevcuttu. Yüz on iki hasta (%80.6) yaralanma öncesindeki ambulasyon seviyelerine döndü. Bütün femoral stemlerde aseptik gevşeme ve osteoliz olmaksızın osteointegrasyon izlendi. Ortalama stem çöküşü 3.1±2.4 (dağılım: 0-18) mm olarak kaydedildi. Çökme derecesi instabil redüksiyon olan hastalarda anlamlı derecede yüksekti. Sağkalım oranı %94.2 olarak bulundu.

Çıkarımlar: Sementsiz bipolar hemiartroplasti, sekizinci dekatta bulunan hastaların intertrokanterik kırık tedavileri için uygun bir metot olarak gözükmektedir. Bununla birlikte, stem çöküşünden kaçınmak için posteromedial fragmanın stabil tespiti gereklidir.

Anahtar Kelimeler

Hemiartroplasti; intertrokanterik kırık; sekizinci dekat; osteoporoz.

Kaynakça

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