Hip Arthroplasty for Inter-Trochanteric Fractures in Elderly

Abstract

Indications for hip arthroplasty in inter-trochanteric fractures include—(a) fresh fractures—unstable fractures in elderly patients or those with pre-existing arthritis and (b) non-union or mal-union of inter-trochanteric fractures. If arthritis is present, then total hip arthroplasty should be done; if not, then hemiarthroplasty can be done. Hip arthroplasty in these cases is technically demanding due to issues such as assessing version, achieving limb length equalization, and preventing varus collapse in comminuted fractures. The goals of treatment are immediate pain relief, early ambulation, and rehabilitation to expedite return to pre-fall ambulatory status and activities of daily living. As compared to hemiarthroplasty, total hip arthroplasty for traumatic indications has the advantage of better functional outcomes and lower reoperation rates, but the rates of dislocation are higher. Reattachment of the trochanteric fragment is absolutely essential to achieve stability and reduce the risk of dislocation.