Journal of Musculoskeletal Trauma

Cementless Bipolar Hemiarthroplasty for Treating Intertrochanteric Fracture in Elderly Patients: Han Jun Lee, Jong Won Kim, Jae Sung Lee, Jae June Yang, Woo Young Hwang; J Korean Fract Soc 2010;23(3):276-281. Published online July 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.3.276

PURPOSE
To evaluate clinicoradiological outcomes after cementless bipoloar hemiarthroplasty in elderly patients with femoral intertrochanteric fractures.
MATERIALS AND METHODS
From March 2006 to February 2008, 28 patients-all in patients greater than 80 years of age, classified unstable intertrochanteric fractures in Evans classification-were followed for more than 1 year. 24 patients were women and 4 patients were men. The mean age of the patients was 84.6 years, the mean follow-up period was 16.3 months. Harris hip score, postoperative inguinal and thigh pain, Parker and Palmer mobility score were analyzed clinically. The radiological results were assessed using various radiological indicies including bone-union, fit and alignment change of femoral stem and vertical subsidence.
RESULTS
The average Harris hip score was 82.9, Parker and Palmer mobility score preoperative 8.0 changed to 5.2 postoperatively. More than moderate pain was presented in 1 case. There were no cases of varus deformity or osteolysis. All stems were stable without significant alignment change or subsidence except 1 case of periprosthetic fracture. There were no dislocation, thromboembolism, death during operation or hospital days.
CONCLUSION
In elderly patients, cementless bipolar hemiarthroplasty is good treatment method of unstable intertrochanteric fracture and short-term clinicoradiological outcomes proved to be satisfactory.

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The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures
Yee-Suk Kim, Jae-Seung Hur, Kyu-Tae Hwang, Il-Yong Choi, Young-Ho Kim
Hip & Pelvis.2014; 26(2): 99. CrossRef

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Bipolar Hemiarthroplasty for Femoral Basicervical Fractures in the Elderly: Duk Hwan Kho, Ki Hwan Kim, Hyeung Jun Kim, Dong Heon Kim; J Korean Fract Soc 2009;22(4):239-245. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.239

Abstract PDF: PURPOSE
To evaluate the results of the treatment of femoral basicervical fractures aged 75 years or older. MATERIALS AND METHODS: We reviewed the clinical records of 60 patients who were older than 75 years and who underwent bipolar hemiarthroplasty for femoral basicervical fractures using calcar replacement stem between March 1999 and November 2005. The minimum follow up period was 2 years. We analyzed the results by conducting radiological and clinical evaluations such as assessing the patient's walking ability and modified Harris hip score, the activities of daily living, the associated medical conditions and arthritis, and postoperative disgnosis. RESULTS: The mean Harris hip score were 87.2 (74~92). Walking ability was recovered in 91% (55 cases) and activity of daily living was achived in 91% (55 cases). Press-fit fixations were 56 cases and bony ingrowth fixations were 57 cases. Stress shields were 28% (17 cases). Thigh pains were 5% (3 cases) and revision rate was 3% (2/60 cases). CONCLUSION: We consider bipolar hemiarthroplasty using calcar replacement stem in femoral basicervical fractures in the Elderly with severe osteoporosis is the useful treatment in view of the stable and rigid fixation of femoral stem, early ambulation, and the low rate of complications and death, even if the operation is technically very difficult.

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Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients: Jin Wan Kim, Young Chul Ko, Chul Young Jung, Il Soo Eun, Hyeon Soo Choi, Ok Gul Kim, Young June Kim; J Korean Fract Soc 2009;22(4):232-238. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.232

Abstract PDF: PURPOSE
To evaluate the clinical and radiological outcome of the greater trochanter reattachment device (GTRD) as firm fixation method for displaced greater trochanter fragment in bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture in elderly patients. MATERIALS AND METHODS: From January 2006 to January 2008, 32 patients above 70 years old treated with bipolar hemiarthroplasty using the GTRD as fixation method for comminuted intertrochanteric femur fracture with greater trochanter bone fragment displaced above 1 cm. They were followed up for more than one year. Clinically, the postoperative Harris hip score (HHS) and daily activities of life of Johnston et al were evaluated, and radiological, any displacement of greater trocharter bone fragments and/or GTRD. RESULTS: The mean postoperative HHS was 71.6 (range, 53~82) points. In rating the daily activity of life, twenty seven (84.4%) patients` postoperative results were above fair. Two patients (6.3%) had displacement of the greater trochanter bone fragment above 1 cm. One patient had a deep infection, so we removed the bipolar head and inserted antibiotics-loaded cement block instead, and after the infection was controlled, conversion to total hip arthroplasty was done. CONCLUSION: In bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture with displaced greater trochanter bone fragment, GTRD produced satisfactory results and early rehabilitation.

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Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty: Myung Sik Park, Woo Chul Jung, Hyuk Park, Byung Yun Hwang, Young Jin Lim, Myung Guk Jung, Hong Man Cho; J Korean Fract Soc 2009;22(3):138-144. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.138

Abstract PDF

PURPOSE
To perform comparative analysis between the results of internal fixation using compression hip screw and cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients.
MATERIALS AND METHODS
From January 2001 to October 2006, we reviewd 73 patients, who were treated surgically for unstable intertrochanteric fractures, with a minimum of 2 years follow up. The patient's age was older than 60 year old. The patients were divided into two groups and evaluated, retrospectively. One group was treated with cemented bipolar hemiarthroplasty (Group A, 34 cases), and the other group was treated with compression hip screw (Group B, 39 cases). We evaluated the amount of intraoperative bleeding, operative time, clinical results and complications between the two groups.
RESULTS
The amount of intraoperative bleeding and operative time were no statistically significant between the two groups. Group A showed a better result than Group B for clinical outcome using Johnson Daily Activity of Life. Complications in the group A were comprised of dislocation (1 case), nonunion of greater trochanter (1 case), infection (1 case) and loosening (1 case), and those in the group B were comprised of loss of fixation (8 cases) and infection (1 case).
CONCLUSION
We found that short-term outcomes of cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures were satisfactory. However, a longer-follow up period is necessary to clarify the efficacy of cemented bipolar hemiarthroplasty.

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Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis
Jun-Il Yoo, Yong-Chan Ha, Jae-young Lim, Hyun Kang, Byung-Ho Yoon, Hyunho Kim
Journal of Korean Medical Science.2017; 32(5): 858. CrossRef
The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures
Yee-Suk Kim, Jae-Seung Hur, Kyu-Tae Hwang, Il-Yong Choi, Young-Ho Kim
Hip & Pelvis.2014; 26(2): 99. CrossRef

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Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Hip Fractures in the Elderly: Duk Hwan Kho, Ki Hwan Kim, Hyeung June Kim, Dong Heon Kim; J Korean Fract Soc 2008;21(3):232-239. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.232

Abstract PDF

PURPOSE
To evaluate the results of bipolar hemiarthroplasty using calcar replacement stem for hip fractures in elderly patients.
MATERIALS AND METHODS
Between March 1995 and March 2005, the clinical records on 68 cases more than 75 years old who underwent the bipolar hemiarthroplasty using calcar replacement stem and followed minimum 2 years were reviewed. We evaluated the results by modified Harris hip score, walking ability, activity of daily living, complications, osteoporosis and radiologic findings.
RESULTS
The mean postoperative modified Harris hip score was 88.3 (69~95) in femoral neck fractures and 83.5 (63~91) in femoral intertrochanteric fractures. Walking ability was recovered in 82.3% (56 cases) and activity of daily living was achived in 82.3% (56 cases). Complications were thigh pain, infection, femoral stem subsidence, stress shield, dislocation.
CONCLUSION
We consider bipolar hemiarthroplasty using calcar replacement stem for unstable hip fractures in elderly patients with severe osteoporosis is the useful treatment in view of the stable and rigid fixation, early ambulation and the low rate of complications, even if the operation is technically very difficult.

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Bipolar Hemiarthroplasty With a Calcar Stem for the Management of a Failed Proximal Femoral Nail Anti-rotation Asia (PFNA2) in a Case of Geriatric Unstable Intertrochanteric Femur Fracture
Mukesh O Phalak, Tushar Chaudhari, Ajinkya K Chaudhari
Cureus.2024;[Epub] CrossRef
Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture
Jeong Hoon Kang, Sang Hong Lee, Sung Jung
Hip & Pelvis.2015; 27(4): 232. CrossRef
Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly
Duk-Hwan Kho, Ju-Yong Shin, Hyeung-June Kim, Dong-Heon Kim
The Journal of the Korean Orthopaedic Association.2009; 44(3): 369. CrossRef
Bipolar Hemiarthroplasty for Femoral Basicervical Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-Jun Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2009; 22(4): 239. CrossRef

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Bipolar Hemiarthroplasty for the Femoral Neck Fractures in Elderly Patients: Woong Kyo Jeong, Sang Won Park, Soon Hyuck Lee, Jong Hoon Park, Suk Ha Lee, Ji Hoon Kang, Gi Won Choi, Won Noh; J Korean Fract Soc 2008;21(1):8-12. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.8

Abstract PDF: PURPOSE
To evaluate the clinical results of bipolar hemiarthroplasty in elderly patients more than 65 years of age with a femoral neck fracture.
MATERIALS AND METHODS
Forty-six bipolar hemiarthroplasties in 43 patients more than 65 years of age which could be followed more than 3 years were included in this study. The clinical outcomes were evaluated using Harris hip score, pain score and support score. The radiological results were analyzed by femoral stem loosening and bipolar cup migration.
RESULTS
The average Harris hip score was 88.7 (62~96) points. An excellent score was recorded in 34 cases, good in 7 cases, fair in 3 cases and poor in 2 cases. The average pain score was 39.3 points and there were no pain in 20 cases, slight pain in 17 cases, mild pain in 6 cases and moderate pain in 2 cases. The average support score was 9.6 points and 32 patients could walk without the use of any assistive devices. Two cases were converted to total hip arthroplasty due to femoral stem loosening with or without bipolar cup migration.
CONCLUSION
For the early ambulation and functional recovery of elderly patients with femoral neck fracture, bipolar hemiarthroplasty was considered as one of recommendable methods.

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Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients: Duk Hwan Kho, Ju Yong Shin, Ki Hwan Kim, Jun Hyuck Lee, Dong Heon Kim; J Korean Fract Soc 2007;20(2):129-134. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.129

Abstract PDF

PURPOSE
To evaluate the results after fixation with figure of eight and cerclage wiring for comminuted trochanteric fracture. Because comminution of the femoral trochanteric fracture in elderly patients is severer in the operating field than x-ray findings, so the fixation is more difficult.
MATERIALS AND METHODS
Between March 1998 and March 2004, the clinical records on twenty-eight patients more than 70 years old who underwent the bipolar hemiarthroplaty using calcar replacement type of femoral stem and followed more than 24 months were reviewed. Figure of eight and cerclage wiring was used for the comminuted trochanteric fracture of the femoral intertrochanteric fracture. The mean age was 80.4 (70~103) years. 19 cases were female, 9 cases were male. Mean follow-up period was 58 (24~92) months. We evaluated the results by modified Harris hip score, walking ability, activity of daily living, radiologic findings and union of the fracture.
RESULTS
The mean duration of bony union was 12 weeks. The mean postoperative modified Harris hip score was 82.3. Preoperative walking ability was recovered in 23 cases (82%). Also basic activity of daily living was recovered in 22 cases (79%). Nonunion of trochanter was found in only one case by radiologic evaluation but clinical correlation was not significant.
CONCLUSION
We consider fixation with figure of eight and cerclage wiring for unstable intertrochanteric fracture of femur in the elderly patient is more appropriate in terms of convenience of fixation, duration of union, early ambulation and cost effectiveness.

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Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures
Chetan Puram, Chetan Pradhan, Atul Patil, Vivek Sodhai, Parag Sancheti, Ashok Shyam
Injury.2017; 48: S72. CrossRef
Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients
Weon-Yoo Kim, Young-Yul Kim, Jae-Jung Jeong, Do-Joon Kang
Hip & Pelvis.2013; 25(4): 274. CrossRef
Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients
Jin-Wan Kim, Young-Chul Ko, Chul-Young Jung, Il-Soo Eun, Hyeon-Soo Choi, Ok-Gul Kim, Young-June Kim
Journal of the Korean Fracture Society.2009; 22(4): 232. CrossRef

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Comparative Study of Bipolar Hemiarthroplasty and Second Generation Intramedullary Nailing on Treatment of Elderly Unstable Peritrochanteric Femoral Fractures: Ho Hyun Yun, Gil Yeong Ahn, Il Hyun Nam, Gi Hyuk Moon, Jae Wook Lee, Jae Cheol Kim; J Korean Fract Soc 2006;19(2):128-134. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.128

Abstract: PURPOSE
To evaluate and compare the clinical and radiological outcome of bipolar hemiarthroplasty and second generation intramedullary nailing for elderly unstable peritrochanteric femoral fracutre.
MATERIALS AND METHODS
From January 2000 to July 2004, 56 elderly unstable peritrochanteric fractures were treated with a bipolar hemiarthroplasty (34 cases) or a ITST intramedullary nailing (22 cases). The fractures were classified using the OTA/AO classification. The clinical results were evaluated by walking capability, hip joint pain, and thigh pain. The radiological results were evaluated on the basis of the radiographs at follow-up.
RESULTS
In bipolar hemiarthroplasty group, The mean operation time was 134 minute, the mean blood loss was 648 ml. In intramedullary nailing group, The mean operation time was 103 minute, the mean blood loss was 386 ml. There were no different walking ability between prefracture and postoperative state in 22 cases (65%) of bipolar hemiarthroplasty group, 18 cases (80%) of intramedullary nailing group respectively. There were 5 cases (14%) hip joint pain in bipolar hemiarthroplasty group and 4 cases (18%) thigh pain in ITST intramedullary nailing group postoperatively.
CONCLUSION
Comparing the operation time, blood loss, and walking ability, ITST intramedullary nailing group show superior clinical outcomes than bipolar hemiarthroplasty group. However, The effort for decreasing postoperative thigh pain might be required.

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Bipolar Hemiarthroplasty of Displaced Femoral Neck Fractures in Pakinsonism Patients: Hyung Ku Yoon, Byung Kuk Kim, Dong Eun Shin, Sang Jun Song, Hyung Kun Park, Ji Hoon Chang; J Korean Fract Soc 2005;18(2):126-130. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.126

Abstract PDF

PURPOSE
To evaluate clinical outcome and functional result after cemented bipolar hemiarthroplasty of displaced neck fracture in parkinsonism patients.
MATERIALS AND METHODS
12 parkinsonism patients treated by cemented bipolar hemiarthroplasty of displaced femur neck fracture from August 1994 to October 2002 were evaluated. Posterolateral approach was performed. Preoperative and postoperative walking ability, activity of daily life and severity of parkinsonism were compared. The effects of parkinsonism on clinical outcome were analyzed retrospectively.
RESULTS
The median difference of walking ability was 1 (p=0.001) and that of ADL scale was -3 (p=0.0005). There was no significant change in the severity of parkinsonism (p=0.5), and the severity and duration of parkinsonism were not correlated with postoperative functional status. 7 cases of voiding difficulty, 5 of temporary delirium, and 2 of temporary respiratory insufficiency were noted as general complications. 2 cases of dislocation and 1 of infection were noted as orthopaedic complications.
CONCLUSION
In parkinsonism patient, walking ability was worsened, activity was more independent, but severity of parkinsonism was not changed after hemiarthroplasty of displaced femur neck fracture. Orthopaedic surgeons should bear in mind that functional outcome is poor and orthopaedic complication rate high in parkinsonism.

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Failure of Long Spinal Construct and Pseudarthrosis in a Patient with Parkinson Disease for the Treatment of Degenerative Lumbar Spinal Disorder: Case Report
Hong Kyun Kim, Hyun Woo Na, Kook Jin Chung
Journal of Korean Society of Spine Surgery.2014; 21(4): 174. CrossRef

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Comparison of Clinical Results between Bipolar Hemiarthroplasty and Compression Hip Screw on Unstable Intertrochanteric Fractures of the Femur in Elderly Patients: Eui seoung Yoon, Hak Jin Min, Jae Seong Suh, Yoon Jong Kim, Hee Seon Kim, Yong Jun Lee, Jeong Min Heo; J Korean Fract Soc 2004;17(3):214-220. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.214

Abstract PDF

PURPOSE
To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients.
MATERIALS AND METHODS
78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test.
RESULTS
The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p<0.05). The mortality rates were 28% and 22% respectively and there were no significant differences statistically (p>0.05).
CONCLUSION
We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.

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Outcomes of Cephalomedullary Nailing in Basicervical Fracture
Seok Hyun Kweon, Sung Hyun Lee, Seng Hwan Kook, Young Chae Choi
Hip & Pelvis.2017; 29(4): 270. CrossRef
Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients
Jin-Wan Kim, Young-Chul Ko, Chul-Young Jung, Il-Soo Eun, Hyeon-Soo Choi, Ok-Gul Kim, Young-June Kim
Journal of the Korean Fracture Society.2009; 22(4): 232. CrossRef
Bipolar Hemiarthroplasty for Femoral Basicervical Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-Jun Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2009; 22(4): 239. CrossRef
Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Hip Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-June Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2008; 21(3): 232. CrossRef
Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients
Duk-Hwan Kho, Ju-Yong Shin, Ki-Hwan Kim, Jun-Hyuck Lee, Dong-Heon Kim
Journal of the Korean Fracture Society.2007; 20(2): 129. CrossRef

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Primary Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fracture of the femur in Elderly patients: Jong Min Sohn, Ju Hae Jahng, Nan Kyung Ha, Seong Tae Cho, Kwang Young Choi; J Korean Soc Fract 2003;16(1):37-44. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.37

Abstract PDF

PURPOSE
The purpose of this study was to evaluate the effectiveness and advantage of bipolar hemiarthroplasty in treatment of unstable femoral intertrochanteric fracture in elderly patients.
MATERIALS AND METHODS
We reviewed 93 patients and followed up more than one year. Group I(n=34, Singh index <3 with more than 70 year old) were treated by bipolar hemiarthroplasty. Group II(n=20) with same condition were treated by compression hip screw. Group III(n=39, Singh index >4 with more than 70 year old) were treated by compression hip screw.
RESULTS
Group I and III patients showed satisfactory result over than good by merle D 'Aubigne hip rating scale. Among Group II(n=20), 16 cases showed under 'poor 'according to functional scale. Complication was 1 cases in group I, 19 cases in group II and 8 cases in group III.
CONCLUSION
We suggest bipolar hemiarthroplasty as first choice of treatment for osteoporotic elderly patients with unstable intertrochanteric fracture, especially who have combined medical problems or poor general condition.

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Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis
Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang
Journal of the Korean Fracture Society.2024; 37(3): 144. CrossRef

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Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Unstable Intertrochanteric Fractures in Elderly Patients: Duk Hwan Kho, Kyou Hyeun Kim, Ju Young Shin, Sin Woo Lim, Dong Heon Kim; J Korean Soc Fract 2003;16(1):22-28. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.22

Abstract PDF

PURPOSE
The purpose of this paper is to analyze the operating time, timing of ambulation, functional results and complications using the calcar replacement stem for the severely comminuted unstable intertrochanteric fractures in the elderly patients.
MATERIALS AND METHODS
From August 1991 through January 2001, 20 elderly patients over the 75 year old patients had undergone bipolar hemiarthroplasty with calcar replacement stem for the treatment of unstable intertrochanteric fractures.
RESULTS
The mean operating time was 45 minutes and mean Harris Hip Score was 84.7. Ambulation with walker was started at post-operative 8 days and full weight bearing was 6.9 weeks, each. Complications were 2 cases of wound infection, 1 case of severe thigh pain and 1 case of dislocation.
CONCLUSION
Early ambulation, functional restoration and decrease of the complications with bipolar hemiarthroplasty using calcar replacement stem for severely comminuted unstable intertrochanteric fractures in elderly patients, therefore this methods seems to be one of the effective treatments.

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Pre- and Perioperative Risk Factors of Post Hip Fracture Surgery Walking Failure in the Elderly
YoungJi Ko
Geriatric Orthopaedic Surgery & Rehabilitation.2019;[Epub] CrossRef
A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE
Maheshwar Lakkireddy, Radhakrishna Rapaka, Naveen Gouru, Shivaprasad Rapur
Journal of Evidence Based Medicine and Healthcare.2015; 2(35): 5447. CrossRef
Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients
Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal
Hip & Pelvis.2012; 24(1): 45. CrossRef

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Comparison Study between Internal Fixation with Compression Hip Screw and Bipolar Hemiarffiroplasty in Unstable Intertrochanteric Fracture: You Sung Suh, Sai Won Kwon, Ho Won Jung, Jong Seok Park, Byung Ill Lee; J Korean Soc Fract 2001;14(4):584-591. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.584

Abstract PDF: PURPOSE
To define the appropriate treatment of unstable intertrochanteric fracture for aged patients by conducting a clinical and roentgenographical comparative analysis of internal fixation with compression hip screw and primary bipolar hemiarthroplasty.
MATERIALS AND METHODS
38 patients aged 65 or above with intertrochanteric fracture of Singh index below grade III or bone mineral density(BMD) -3.0 who had both severe osteoporosis and unstable fracture, from the period of January 1995 to January 2000. The 38 patients had either internal fixation with compression hip screw(18 cases, Group I) or primary bipolar hemiarthroplasty(20 cases, Group II), and were followed-up for at least one year afterwards. To prevent postoperative complication, early ambulation was permitted as early as possible to both groups.
RESULTS
The average age was 76(range 65-87) for Group I and 79.8(range 78-92) for Group II, respectively. 19 patients were diagnosed to have I-c fracture, following Evans Classification. 35 cases(92.1%) were given grade III or below according to the preoperative Singh index, while all cases showed severe osteoporosis with average bone density of -4.26(-6.95 ~ -2.54). 60% of Group II were given very good or above diagnosis following Merle d'AubignÃ¨'s postoperative functional outcome, compared with 16.7% of Group I, thus showed statistic difference of p=0.006. The average for postoperative Harris hip score was also higher with 77 points(range 43-95) for Group I than with 86 points(range 57-94) for Group II, thus showed statistic difference of p=0.0216.
CONCLUSION
For aged patients with unstable intertrochanteric fracture, primary bipolar hemiarthroplasty is considered to have better clinical and roentgenographical results, and able to decrease local and general complications, compared with internal fixation with compression hip screw.

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Treatment of intertrochanteric fractures with bipolar hemiarthroplasty in the elderly: Kyou hyeun Kim, Duk hwan Kho, Joon ho Yang, Dong heon Kim; J Korean Soc Fract 2001;14(2):174-180. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.174

Abstract PDF

PURPOSE
To compare the timing of ambulation, complications and functional results between the autogenous femoral head graft and the calcar replacement type stem in the severe comminuted fracture of the elderly patients with unstability.
MATERIALS AND METHODS
25 intertrochanteric femoral fracture patients who had bipolar hemiarthroplasty were followed for more than 1 year. 17 patients had autogenous femoral head graft and 8 patients had calcar replacement type stem.
RESULT
The mean operating time for autogenous femoral head graft was 1.7 hours, and calcar replacement type stem was 1.3 hours. Postoperative Harris functional score was 84.1 for the autogenous femoral head graft group and 82.2 for the calcar replacement type stem group.
Discussion
: Both autogenous femoral head graft augmentation and fixation using the calcar replacement type stem result in rigid fixation, which enables the patients to ambulate early and to have low complication rate. Both techniques seem to be effective for the treatment of intertrochanteric fractures.

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Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis
Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang
Journal of the Korean Fracture Society.2024; 37(3): 144. CrossRef
Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture -
Chae-Hyun Lim, Young-Yool Chung, Jeong-Seok Kim, Chung-Young Kim
Hip & Pelvis.2013; 25(1): 44. CrossRef
Bipolar Hemiarthroplasty for Hip Fractures in Patients Aged over 90 Years - The Factors Influencing the Postoperative Mortality -
Jun-Dong Chang, Je-Hyun Yoo, Sang-Soo Lee, Tae-Young Kim, Kyu-Hak Jung, Yong-Kuk Kim
Hip & Pelvis.2010; 22(4): 283. CrossRef

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Treatment of trochanteric fractures of the femur in osteoporotic patients: Joo Tae Park, Chang Sung So, Jae Yong Byun, Kyung Ho You, Ho Yeun Hwang; J Korean Soc Fract 2001;14(1):16-22. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.16

Abstract PDF: PURPOSE
To determine more useful method by comparing the functional recovery and postoperative complications according to operative methods in treatment of unstable trochanteric fracture of the femur with osteoporotic bone.
MATERIALS AND METHODS
Of 45 cases with unstable femoral trochanteric fracture with osteoporosis who had been able to ambulate before injury, we compared postoperative functional recovery and complications between 25 cases treated by cemented bipolar hemiarthroplasty and 20 cases treated by dynamic compression hip screw.
RESULTS
Of 45 cases who had been treated by cemented bipolar hemiarthroplasty and dynamic compression hip screw, the functional results, according to the rating scale of Merle d Aubigne were rated as above good in 23 cases and 14 cases, respectively and postoperative mechanical complications were found in 2 cases and 7 cases, respectively. There was statistically significant difference(P<0.05).
CONCLUSION
Unstable trochanteric fracture of the femur with osteoporotic bone treated by cemented bipolar hemiarthroplasty showed good functional results and few mechanical complications for short term follow-up.

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Primary Bipolar Hemiarthroplasty for the Treatment of Unstable Intertrochanteric Fractures in Elderly Patients: You Sung Suh, Sung Tae Kim, Soo Jae Yim, Yon Il Kim, Soo Kyoon Rah, Chang Uk Choi; J Korean Soc Fract 2000;13(2):222-229. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.222

Abstract PDF

PURPOSE
: The purpose of this paper was to present the clinical and roentgenographic results were obtained with bipolar hemiarthroplasty as a primary treatment for comminuted unstable intertrochanteric fracture in elderly patients with severe osteoporosis. The goal of this treatment is early ambulation with early weight bearing to prevent the complications such as a deep vein thrombosis, pulmonary embolism, pneumonia or atelectasis, and pressure sore.
MATERIALS AND METHODS
: Twenty consecutive patients who were more than seventy years old with severe osteopotosis and had an comminuted unstable intertrochanteric fractures were treated by primary bipolar hemiarthtoplasty from January 1995 through January 1998 at the Department of Orthopaedic Surgery of Soonchunhyang University Hospital. If there were fractured at the lesser or the greater, a circlage wire or Dall-Miles system (trochanter cable grip system) was passed through the lesser and the greater trochnater to permit its subsequent fixation to the medial and the lateral side of the femoral component. The functional results were judged according to the hip rating scale of Merle d' Aubigne.
RESULTS
: The mean age at operation was 79.8(70 to 92) years old. The most common type according to the Evans classification system was I -d(10 cases, 50%). Singh index was case(5%) of Grade I , 7 cases(35%) of Grade II, 10 cases(50%) of Grade III and 2 cases(10%) of Grade IV. The mean bone mineral density(BMD) was -4.24(-6.95 - -3.17). The functional results in 75% of the patients were rated as excellent, very good, or good and in 25% as fair, poor, or bad.
CONCLUSION
: Primary bipolar hemiarthroplasty for the treatment of comminuted unstable intertrochanteric fractures in elderly patients with severe osteoporosis could return these patients to their pre-injury level of activity quickly, thus obviating the postoperative complications caused by immobilization.

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A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE
Maheshwar Lakkireddy, Radhakrishna Rapaka, Naveen Gouru, Shivaprasad Rapur
Journal of Evidence Based Medicine and Healthcare.2015; 2(35): 5447. CrossRef

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Comparison of Bipolar Hemiarthroplasty and Compression Hip screw on Treatment of Elderly Unstable Intertrochanteric Fractrues: Ik Su Choi, Su In Roh, Dae Yeon Kim, Keun Il Lee, Seung Chan Ko; J Korean Soc Fract 2000;13(1):56-63. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.56

Abstract PDF: PURPOSE
To evaluate and compare the clinical outcomes of bipolar hemiarthroplasty and compression hip screw on elderly with unstable intertrochanteric fractures We evaluated the clinical results of 65-year or older elderly patients with unstable intertrochanteric fractures between Jan. 1993 to Dec. 1997. 23 patients underwent compression hip screw treatment and 19 patients were treated with bipolar hemiarthroplasty. Functional evaluation was conducted at 3, 6 and 12 month after the operation by hip rating scale of Merle d'Aubigne. Complications, time to weight bearing and hospitalization period were also investigated.
RESULTS
For the bipolar hemiarthroplasty group, functional scale of good or above were seen in 74%, 72% and 67% of the group at 3 months, 6 months and 12 months. However in the compression hip screw group, the good or above results were shown in 57%, 52% and 43% of the group, thus showing a functional deterioration as time progresses. Comparing the overall clinical outcome, the bipolar hemiarthroplasty group showed better results, complication occurred in 26 cases of compression hip screw group and 8 cases of bipolar hemiarthroplasty group, showing better outcomes in the bipolar hemiarthroplasty group.
CONCLUSION
Comparing the length of hospital stay, time to weight bearing, complication and functional superiority of the treatment for elderly unstable intertrochanteric fractures, the bipolar hemiarthroplasty showed superior clinical outcomes than the compression hip screw. Moreover, patients with more unstable fractures and more severe osteoporosis showed better clinical results with bipolar hemiarthroplasty.

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Cemented Hemiarthroplasty in Femoral Neck Fractures over 70 Years : A Matched-Pair Analysis of unipolar and Bipolar Hemiarthroplasty: Kang Sup Yoon, Seung Baik Kang, Ji Ho Lee, Jin Soo Tark, Hyeok Rhyou; J Korean Soc Fract 1999;12(4):773-779. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.773

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PURPOSE
: The goal of treatment in elderly patients with hip fractures is restoration of function We analysed the clinical efficacy of the cemented unipolar hemiarthroplasty and bipolar hemiarthroplalty for the treatment of femoral neck fractures in elderly patients over 70 years. Twenty-four pairs of patients who had a cemented hemiarthroplasty were studied with a retrospective and matched-pair analysis. Half of the patients had received a cemented bipolar hemiarthroplasty and the other half, a cemented unipolar hemiarthroplasty The patients were matched for age, sex, femoral head size, physical status and the ability to walk. At one year follow-up, the frequency of the pain and the limp were 41.7% and 54.2%, respectively, in the unipolar group and 45.8% and 45.8%, respertively, in the bipolar group. The ability to live independently was 66.7% in the unipolar group and 79.2% in the bipolar group. None of these differences were statistically significant. The frequency of the return to the level of function before injury was 37.5% in unipolar group and 45.8% in the bipolar group, which was also not significantly different. Flexion of the hip joint was 96.7+/-6.9 in unipolar group and 101.5+/-7.3 in the bipolar group(p=0.02). Abduction and rotational motion was not significantly different in two groups. There were no revisions in either group. Cemented bipolar hemiarthroplasty did not show better clinical results than cemented unipolar group.

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Bipolar Hemiarthroplasty for the Femoral Neck Fractures in Elderly Patients
Woong-Kyo Jeong, Sang-Won Park, Soon-Hyuck Lee, Jong-Hoon Park, Suk-Ha Lee, Ji-Hoon Kang, Gi-Won Choi, Won Noh
Journal of the Korean Fracture Society.2008; 21(1): 8. CrossRef

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Bipolar Hemiarthroplasty for the Treatment of Displaced Femoral Neck Fracture in Elderly Patients: Uncemented versus Cemented femoral stems: Jae Yeul Choi, Kyung Chul Kim, Hwa Jae Jeong, Bon Seop Koo, Ho Joong Lee; J Korean Soc Fract 1999;12(2):195-202. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.195

Abstract PDF: Forty five patients above the age of 60 with displaced femoral neck fractures were treated by bipolar hemiarthroplasty in Kangbuk Samsung hospital from January 1990 to January 1995. We evaluated these patients for comparison of the results between the cemented and uncemented femoral fixation, especially in elderly patients with medical illness or osteoporosis. During a follow up period of more than two years, the authors found less thigh pain(5.2% versus 38%) and slightly higher Harris hip scores(84.5 versus 80.0 points) in the cemented group in comparison with the uncemented group. Radiographic examination showed less radiolucent zones in the cemented group. Comparing the operative time(86.2 versus 83.8 minutes), hospital stay(4.7 weeks versus 5.3 weeks), blood loss(385 versus 381 ml) during the operation. The postoperative mortality rate was 2%, and the follow-up mortality rate was 11% in the first year. There was no significant difference between two groups in mortality rate. Thus in bipolar hemiarthroplasty in elderly patients with displaced femoral neck fracture, we have obtained satisfactory results despite of poor bone condition and osteoporosis except thigh pain. But the follow up period was too short to assess the late complications of the hemiarthroplasty such as acetabular erosion, implant loosening, so long-term follow up will be necessary

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Clinical Results of Cemented Bipolar Arthroplasty in Femur Neck Fractures over 70 Years: Hyung Ku Yoon, Ho Seung Jeon, Kye Nam Cho, Jong Wha Yi; J Korean Soc Fract 1998;11(2):313-320. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.313

Abstract PDF: There have been much controversy about prosthetic replacement or internal fixation for patients over 70 years old. Authors reviewed and analyzed 45 cases of cemented bipolar hemiarthroplasty in patient over 70 years treated at the Department of Orthopedic Surgery, Sung-Ae General hospital from January 1988 to July 1995. The purpose of this study was to analyse the clinical and radiological results and to detect the motion study of bipolar cup. Follow up period was average 26.1 months, ranged from 24 months to 37 months. The following results were obtained. 1. In clinical evaluation, excellent & good result were in 31 cases(68.6%). 2. In radiologic evaluation, acetabular erosion were in 2 cases and loosening of the femoral component was in 1 case. 3. With time elapsed, the amount of the inner bearing motion was decreasing with preservation of the total joint motion. 4. Complications were idiopathic pain 7 cases, nerve paresis 2 cases, superficial infection 2 cases, intraoperative fracture 1 case, dislocation 1 case, losening 1 case.

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Experience with Bipolar Hemiarthroplasty in Femoral Neck Fracture in the Elderly Patients: Correlation Between Preoperative Medical Conditions and Postoperative Functional Results of Hip: Kwang Hee Lee, Se Dong Kim, Dong Chul Lee, Duk Seop Shin; J Korean Soc Fract 1998;11(1):143-152. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.143

Abstract PDF

The displaced femoral neck fracture remains a major challenge to orthopedic surgeons, as the elderly population is increasing. Elderly patients with femoral neck fractures often have other medical conditions, fragile bones, and poor compliance. Thus, for elderly patients who need early ambulation and funtional recovery, bipolar prosthesis is accepted as an appropriate treatment. We report a study of 58 cases of bipolar hemiarthroplasty with a femoral neck fracture and a physiologic age older than 65 years from January 1991 to May 1996. The purpose of this study is to evaluate the functional outcome of bipolar hemiarthroplasty and correlation between preoperative medical conditions and Harris hip score in femoral neck fractures in the elderly patients. The results obtained were as followings. 1. 90% of patients had uncontrolled medical conditions. Cardiovascular and pulmonary disease were main preexisting medical conditions. 2. The preoperative medical conditions were important deteminants for the functional results after bipolar hemiarthroplasty. 3. Dislocated bipolar prosthesis needed open reduction or revision to total hip arthroplast due to disassembly of the prosthesis caused by attempted closed reduction.

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Usefulness of the Cementless Stem for the Treatment of Hip Fracture in Elderly Patients with Osteoporosis - Comparative Analysis between Cementless Stem and Cemented Stem -
Joon Soon Kang, Kyoung Ho Moon, Rhu Seop Kim, Sang Ho Lee, Jong Min Choi
Journal of the Korean Fracture Society.2011; 24(1): 16. CrossRef

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Bipolar Hemiarthroplasty Inserted with Cement for the femoral Neck Fractures in Elderly Patients: Sang Won Park, Young Soo Byun, Gyou Hyouk Lee, Jong Won Kim; J Korean Soc Fract 1997;10(3):509-515. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.509

Abstract PDF: Elderly patients with femoral neck fracture often have other medical diseases, poor bone quality and poor compliance which make it more difficult to obtain satisfactory results after internal fixation. Therefore, prosthetic replacement is accepted as an appropriate treatment for elderly patients. The purpose of this study was to analize clinical results of cemented bipolar hemiarthroplasty in the femoral neck fractures of elderly patients. The authors analyzed thrity-seven patients with 38 fractures of the femoral neck older than 65 years of age who were treated with cemented bipolar hemiarthroplasty from Jan. 1991 to Dec. 1995. The average follow-up period was three years, ranged from one to five years. The functional results were evaluated according to the criteria of the Harris hip score The results obtained were as follows : 1. The average Harris hip score was 84.6 points, ranged from 61 to 97 points. 2. The average pain score was 40.3 points. Twelve cases did not complain of pain, slight pain in 26 cases and mild pain in 2 cases. 3. The average limping gait score was 8.9 points. Twelve cases had no limping gait, slight limping in 25 cases and moderate limping in one case. 4. The average support score was 8.4 points. Seventeen cases could be walked without support, sixteen cases did use cane for long walk, two cases did use cane at full time, and three cases did use crutch. 5. Intraoperative complications were partial fracture of greater trochanter in 2 cases and one non-displaced calcar fracture. 6. Postoperative complications were heterotopic ossification in 2 cases, dislocatioin of bipolar cup with proximal migration in 1 case and ipsilateral femur fracture below the tip of femoral stem in 1 case. Above results suggest that the cemented bipolar hemiarthroplasty for femoral neck fracture in elderly patients appears to be a method of treatment better than internal fixation for early ambulation and functioinal recovery.

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Primary Bipolar Hemiarthroplasty Compared with Compression Hip Screw on Treatment of Elderly Unstable Intertrochanteric Fractures: Jae Ick Lee, Myung Hwan Son, Seong Geun Heo, Young Ho Gwun, Jae Hong Park; J Korean Soc Fract 1996;9(2):401-408. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.401

Abstract PDF

The incidence of intertrochanteric fracture of the femur appears to be increasing, Particularly the more unstable comminuted fracture types are increasing, paralleling increased longevity in the population. Fourteen cases were treated with primary bipolar hemiarthroplasty and eighteen cases were treated with compression hip screw at the Department of Orthopaedic Surgery of Pusan City Medical Center from June 1991. to June 1993. The results obtained were as follows; 1. In the bipolar hemiarthroplasty group, rehabilitation was easier and faster, and the incidences of pressure sore, pulmonary infection & atelectasis were significantly lower. 2. The early walking with full weight bearing that the bipolar hemiarthroplasty made possible is considered to be a major contributing factor to those results.

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Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients
Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal
Hip & Pelvis.2012; 24(1): 45. CrossRef

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Bipolar Hemiarthroplasty for the Treatment of Femoral Neck Fracture in Elderly Patients: Kwon Jae Roh, Dong Wook Kim; J Korean Soc Fract 1995;8(4):747-752. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.747

Abstract PDF: Displaced intracapsular fracture of the hip remains a formidable problem in orthopaedic management despite advances in surgical technique and hardware. Advances in internal fixation have lowered the morbidity from prolonged bed rest and shortened the time of mobilization , however, the incidence of nonunion End avascular necrosis remains high. As a result, prosthetic replacement has been advocated as a solution to this problem. But, sepsis, dislocation and late loosening remain real concoern. So we reviewed the follow-up(range, twelve to sixty months) results of forty bipolar hemiarthroplasty for the displaced femoral neck fracture in elderly patients. The average age of the patients was seventy-four and the common cause of injury was slipped down. In the type of fracture, anatomically subcapital(21), Garden stage IV(19), and Pauwel typeII (21) was the most common. The associated medical conditions were chronic lung disease(10), chronic heart disease(8), diabetes mellitus(7), chronic liver disease(5). Two patients died of hepatoma and liver cirrhosis during the follow-up periods. The results were followed; 1. The most common used prosthesis was Centralign and cement was used in 32 cases. 2. Above 80% wereexcellent or goodin Luncefords criteria and Harris hip score. 3. The complications were transient peroneal nerve palsy(2), intractable thigh pain(2), deep wound infection(1), proximal femoral fracture(1). In conclusion, bipolar hemiarthroplasty seems to be a good alternative to the internal fixation in elderly patients with a displaced femoral neck fracture.

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