Primary versus secondary calcar replacement hip arthoplasty for treatment of unstable trochanteric fractures

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Abstract

Background

Harris and Allen had modified and described a calcar replacement femoral component, which is necessary for the conventional femoral components, as a part of total hip replacement to address many problems related to proximal femoral deficiency. The aim of this study was to compare the clinical and radiological outcomes of a primary salvage calcar replacement hip arthroplasty with secondary salvage calcar replacement hip arthroplasty for treatment of new (group 1, prospective) or failed osteosynthesis or end prosthesis treatment (group 2, retrospective) of unstable trochanteric fractures.

Patients and methods

Fifteen patients were included in each group, with a mean age of 67.3 years for group 1 patients and 65.8 years for group 2 patients. The female-to-male ratio was 8 : 7 in group 1 and 10 : 5 in group 2. Incidence of preoperative comorbidities was 2.2 per patient in group 1 and 2.0 per patient in group 2. The mean time from the initial unstable trochanteric fracture to the time of calcar replacement hip arthroplasty was 4.2 days and 12.4 months in group 1 and group 2, respectively. The posterolateral approach using the posteriorKocher–Langenbeck proximally and the posterolateral approach distally for the proximal femur without trochanteric osteotomy. All patients were followed up clinically and radiologically, and at the end of the follow-up period (1–3 years) the Merle d’Aubigne and Postel score was used for functional evaluation.

Results

The mean operative time was 105 and 155 min, the mean amount of blood loss was 550 and 850 ml, and the mean period of hospital stay was 11 and 21 days for group 1 and group 2 patients, respectively. Two patients in group 2 had required postoperative ICU admission. Postoperative complication(s) were reported in one patient (6.6%) in group 1 and in five patients in group 2. Postoperative psychological problems and mortality during the first year were reported in three patients (20%). The Merle d’Aubigne and Postel functional outcome score by the end of the first year was found to be satisfactory (above 14 points) in 100 and 93.3% of patients in group 1 and group 2, respectively. After 3 years of follow-up it was satisfactory in 83.3 and 66.7% of patients in group 1 and group 2, respectively.

Conclusion

Primary cemented calcar replacement hip arthroplasty for treatment of unstable trochanteric fractures is associated with lesser pain, better walking ability without mortality or psychological problems, and with measurable better overall functional outcomes compared with salvage calcar replacement hip arthroplasty.

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