ROLE OF HIP ARTHROPLASTY IN TROCHANTERIC FRACTURES IN ELDERLY POPULATION

Introduction: Trochanteric fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia, pulmonary embolism, bed sores, increased morbidity. Materials and Methods: We had done a clinical, observational and prospective type study in 34 cases of trochanteric fracture of femur where 12 cases were operated with uncemented bipolar hemiarthroplasty, 11 cases were treated with cemented bipolar hemiarthroplasty and 11 cases were treated with total hip arthroplasty. Results: Patients were followed up for minimum 6 months duration. Out of which, 14 patients died within 6 months of their fractures because of associated systemic comorbidities. According to Harris hip Score, out of 20 cases, 3 cases (15%) had excellent outcome, 5 cases (25%) had good outcome, 6 cases (30%) had satisfactory outcome and 6 cases (30%) had unsatisfactory outcome. Cases treated with uncemented bipolar hemiarthroplasty had satisfactory to unsatisfactory outcome. Cases treated with cemented bipolar hemiarthroplasty had good outcome and cases treated with total hip arthroplasty had excellent to good outcome. Conclusion: Total hip arthroplasty and Cemented bipolar hemiarthroplasty both are reliable treatment methods for unstable trochanteric fractures in elderly osteoporotic patients. Hip arthroplasty offers the potential for early ambulation with little risk of mechanical failure, avoid the risks often associated with internal fixation and prolonged immobilization, and enable patients to maintain a good level of function immediately after surgery. However, as our study group is small, so further large randomized trial required before reaching conclusion.