Role of hemiarthroplasty in intertrochanteric fractures in elderly osteoporotic patients: a case series

  • Ramchander Siwach
  • Hemant Jain
  • Roop Singh
  • Kapil Sangwan
Original Article



Management of intertrochanteric fractures in elderly osteoporotic patients continues to be a challenging problem for orthopedic surgeons. Cutting out of implant from the femoral head and varus malpositioning of fragments is often seen in such cases if early ambulation is allowed. Prolonged bed rest in elderly patients leads to higher risk of complications such as bed sores, pneumonia and deep vein thrombosis not uncommonly leading to fatal pulmonary embolism. The purpose of this case series study was to assess the role of hemiarthroplasty in the treatment of intertrochanteric fractures in elderly patients and study the complications.

Materials and methods

Twenty-five patients were treated at a tertiary care center with hip hemiarthroplasty in intertrochanteric fractures. Mean age of the patients in the study was 77.8 years. Young patients with stable fractures and patients with active infection were excluded from study. Seventy-two percent of patients in the study were osteoporotic and associated comorbidity was present in 18 patients. Preoperative ambulatory status of all patients was noted for comparison. If calcar was deficient, calcar was reconstructed with a cut autograft from the femoral neck.


All Patients were followed for 1 year and evaluated using Modified Harris Hip Score except one patient who expired in postoperative period probably due to embolism. He had poor cardiopulmonary reserve preoperatively and cement was used in this case. Average period of initiation of full weight bearing in the present study was 5.5 days. Excellent/good results were seen in 20 patients (80%). One of the patients, who remained bedridden even after surgery, developed decubitus ulcer on the back and was labeled as failure. This patient expired 9 months after surgery. Dislocation of prosthesis was not seen in any case. One patient had shortening more than 1.5 cm due to sinking of prosthesis.


Although majority of patients with intertrochanteric fractures can be successfully managed with osteosynthesis, older patients with severe osteoporosis and associated comorbidity may benefit from prosthetic replacement. However, large scale studies are required to prove it conclusively.


Hemiarthroplasty Intertrochanteric fractures Osteoporosis 

Supplementary material

590_2011_870_MOESM1_ESM.jpg (4.1 mb)
Supplementary material 1 (JPEG 4216 kb)
590_2011_870_MOESM2_ESM.jpg (4.3 mb)
Supplementary material 2 (JPEG 4428 kb)
590_2011_870_MOESM3_ESM.jpg (3.9 mb)
Supplementary material 3 (JPEG 4013 kb)
590_2011_870_MOESM4_ESM.jpg (4.1 mb)
Supplementary material 4 (JPEG 4234 kb)
590_2011_870_MOESM5_ESM.jpg (685 kb)
Supplementary material 5 (JPEG 685 kb)
590_2011_870_MOESM6_ESM.jpg (681 kb)
Supplementary material 6 (JPEG 680 kb)


  1. 1.
    Butt MS, Krikler SJ, Nafie S, Ali MS (1995) Comparison of DHS and Gamma nail: a prospective randomized controlled trial. Injury 26(9):615–618PubMedCrossRefGoogle Scholar
  2. 2.
    Bridle SH, Patel AD, Bircher M, Calvert PT (1991) Fixation of intertrochanteric fractures of femur: a randomized prospective comparison of the Gamma nail and DHS. Br J Bone Joint Surg 73:330–334Google Scholar
  3. 3.
    Halder SC (1992) The Gamma nail for peritrochanteric fractures. Br J Bone Joint Surg 74B:340Google Scholar
  4. 4.
    Leung KS, Sow S, Sen WY, Hui PW (1992) Gamma nails and dynamic hip screws for peritrochanteric fractures. Br J Bone Joint Surg 74B:345Google Scholar
  5. 5.
    Grimsurd C, Monzon RJ, Richman J, Ries MD (2005) Cemented hip arthroplasty with a novel circlage cable technique for intertrochanteric hip fractures. J Arthroplasty 20(3):337–343CrossRefGoogle Scholar
  6. 6.
    Stern MB, Goldstein TB (1977) The use of Leinbach prosthesis in intertrochantric fractures of hip. Clin Orthop 128:325–329PubMedGoogle Scholar
  7. 7.
    Pho RWH, Nather A, Tong GO, Korken CT (1981) Endoprosthetic replacement of unstable, comminuted 17 fractures of femur in the elderly osteoporotic patient. Trauma 21:792–797CrossRefGoogle Scholar
  8. 8.
    D’Arcy J, Devas M (1976) Treatment of fractures of femoral neck by replacement with Thompson prosthesis. J Bone Joint Surg 58-B:279–286Google Scholar
  9. 9.
    Long JW, Bateman KnightW (1980) UPF prosthesis in fractures of femoral neck. Clin Orthop 152:198–204PubMedGoogle Scholar
  10. 10.
    George Haidukenych J, Berry DJ (2003) Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg 85A:899–904Google Scholar
  11. 11.
    Dimon JH III, Hughston JC (1967) Major components of unstable trochanteric fractures. J Bone Joint Surg 49A:440–444Google Scholar
  12. 12.
    Sarmiento A (1975) Valgus osteotomy technique for unstable trochanteric fractures. In: Proceedings of third open scientific meeting of hip society. CV Mosby, St. Louis, 157–169Google Scholar
  13. 13.
    Ecker MLM, Joyce JJ, Kohe JE (1975) The treatment of trochanteric hip fractures, a compression screw fixation. J Bone Joint Surg 87A:23–27Google Scholar
  14. 14.
    Laros GS, Moore JF (1974) Complications of fixation in joint fractures. Clin Orthop 101:110–119PubMedGoogle Scholar
  15. 15.
    Tronzo R (1974) Use of endoprosthesis for severly comminuted trochanteric fractures. Clin orthop North Am 5(4):679–682Google Scholar
  16. 16.
    Haentjens P et al (1989) Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. J Bone Joint Surg 71-A:1214Google Scholar
  17. 17.
    Chan KC, Gurdev SG (2000) Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop 371:206–215PubMedCrossRefGoogle Scholar
  18. 18.
    Laskin RS, Gruber MA, Zimmerman AJ (1979) In tertrochanteric fractures of the hip in elderly. A retrospective analysis of 236 cases. Clin Orthop 141:188–195PubMedGoogle Scholar
  19. 19.
    Geiger F, Heizel C (2007) Trochanteric fractures in the elderly. The influence of primary hip arthroplasty on 1 year mortality. Arch Orthop Trauma Surg 127:959–966PubMedCrossRefGoogle Scholar
  20. 20.
    Dobbs RE, Parvizi J, Lewallen DG (2005) Perioperative morbidity and 30 day mortality after intertrochanteric hip fractures treated by internal fixation or arthroplasty. J Arthrop 20(8):963–966CrossRefGoogle Scholar
  21. 21.
    Green S, Moore T, Proana F (1987) Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res 224:169–177PubMedGoogle Scholar
  22. 22.
    Kim SY, Kim YG, Hwong JK (2005) Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. J Bone Joint Surg 87A:2186–2192CrossRefGoogle Scholar
  23. 23.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg 51A:737Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ramchander Siwach
    • 1
  • Hemant Jain
    • 1
    • 2
  • Roop Singh
    • 1
  • Kapil Sangwan
    • 1
  1. 1.Department of OrthopaedicsPGIMSRohtakIndia
  2. 2.JaipurIndia

Personalised recommendations