Total hip arthroplasty for treatment of elderly patients with comminuted intertrochanteric fracture accompanied by femoral head necrosis.

OBJECTIVE: To assess the curative effect and investigate the indications of total hip arthroplasty for treatment of comminuted intertrochanteric fractures.

METHODS: Total hip arthroplasty was carried out in 9 cases of severe intertrochanteric fracture. The patients included two men and seven women. The average age of the patients was 68 years (48-75 years). The period from fracture to operation was 5 days (2-10 days). The mean follow-up period lasted for 11 months (3 months-2 years). There was one patient with comminuted intertrochanteric fracture accompanied by femoral head necrosis and 2 patients with intertrochanteric fracture and stroke. Other 6 patients had severe osteoporosis. The Harris score before operation was 63 points (45-71 points).

RESULTS: At the last follow-up, the patients gained 86 points (70-100 points) according to the Harris score. The effects of the 8 cases were good. The Harris score of all patients improved after treatment. Only two hemiplegia patients needed sticks to walk. The others could walk without hip pain. No radiographic evidence of acetabular wear and prosthesis dislocation or other major complications happened during the follow-up.

CONCLUSIONS: Prosthetic replacements can well treat unstable intertrochanteric fracture if operative indication is correctly selected. It is suitable for elderly patients and the operation should be performed by experienced surgeons.