Cementless Calcar-Replacement Hemiarthroplasty Compared with Intramedullary Fixation of Unstable Intertrochanteric Fractures: A Prospective, Randomized Study

• Published in: Journal of bone and joint surgery. American volume 2005-10, Vol.87 (10), p.2186-2192
• Main Authors: Kim, Shin-Yoon, Kim, Yong-Goo, Hwang, Jun-Kyung
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Biological and medical sciences; Bone Cements; Bone Nails; Diseases of the osteoarticular system; Female; Fracture Fixation, Intramedullary; Hip Fractures - surgery; Hip Prosthesis; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Orthopedic surgery; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.D.02768

BackgroundUnstable intertrochanteric fractures in elderly patients are associated with a high rate of complications. The purpose of this investigation was to compare the results of long-stem cementless calcar-replacement hemiarthroplasty with those of treatment with a proximal femoral nail for unstable intertrochanteric fractures in elderly patients.MethodsFifty-eight elderly patients with an AO/OTA type 31-A2 intertrochanteric fracture of the femur were randomized into two treatment groups and were followed for a minimum of two years. The twenty-nine patients in Group I were treated with a long-stem cementless calcar-replacement prosthesis, and the twenty-nine patients in Group II were treated with a proximal femoral nail. The two treatment groups were comparable with regard to demographic and injury variables.ResultsThere were no significant differences between the groups in terms of functional outcomes, hospital stay, time to weight-bearing, or general complications. Patients treated with a proximal femoral nail had a shorter operative time, less blood loss, fewer units of blood transfused, a lower mortality rate, and lower hospital costs compared with those treated with the long-stem cementless calcar-replacement prosthesis.ConclusionsIn elderly patients with an unstable intertrochanteric femoral fracture, a proximal femoral nail provides superior clinical outcomes but no advantage with regard to functional outcome when compared with a long-stem cementless calcar-replacement arthroplasty.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.