Cementless distal fixation modular stem without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more.
INTRODUCTION
Hemiarthroplasty (HA) using standard-length femoral stem with reconstruction of femoral calcar or using calcar replacing prosthesis for unstable intertrochanteric fractures in elderly patients is a viable option. However, both of the techniques increase the complexity of procedure, operative trauma and complication. This study evaluated the clinico-radiological results of the MP-Link cementless distal fixation modular prosthesis without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more.


HYPOTHESIS
Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, do not need to reconstruct the femoral calcar.


MATERIALS AND METHODS
Forty-two patients (42 hips) underwent bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures from January 2008 to January 2012. Five (11.9%) patients were lost to follow-up. The 37 remaining patients (37 hips) were available for evaluation. The mean age was 83.9±5.2 years. Their clinico-radiological data were prospectively gathered.


RESULTS
All of 37 patients, 4 patients (10.8%) died within 1 year postoperatively. At the final follow-up, 31 (83.8%) out of 37 patients were regained preoperative ambulatory status; the mean Harris hip score (HHS) of the 15 patients who died during the follow-up period of 7-59 months, was 84.5±2.4 points; the 22 healthy patients were followed for 68.6±14.7 months, with mean HHS of 84.6±2.8 points. Radiologically, none of stems had evidence of loosening; 16 stems had subsidence of 2-3mm without clinical significance; the bone in-growth fixation was achieved in 24 patients and stable fibrous fixation in 13 patients.


DISCUSSION
Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, without reconstruction of the femoral calcar, may achieve a satisfactory clinico-radiological outcome, and could regain preoperative ambulatory status in most patients (83.3%).


LEVEL OF EVIDENCE
IV, Retrospective study.
['Zha|Guo-Chun|GC|', 'Liu|Jia|J|', 'Wang|Yong|Y|', 'Feng|Shuo|S|', 'Chen|Xiang-Yang|XY|', 'Guo|Kai-Jin|KJ|', 'Sun|Jun-Ying|JY|']
D000368:Aged D000369:Aged, 80 and over D019644:Arthroplasty, Replacement, Hip D001843:Bone Cements D005260:Female D005593:Fracture Fixation, Internal D006620:Hip Fractures D006622:Hip Prosthesis D006801:Humans D008297:Male D011184:Postoperative Period D011859:Radiography D012189:Retrospective Studies
Intertrochanteric fracture Cementless modular stem Old age