Efficacy Of Two-step Osteotomy Combined With Cementless Long-stem Hip Prosthesis Implantation For Treatment Of Femoral Intertrochanteric Fracture In The Elderly

Objective:To determine the efficacy of two-step osteotomy combined with cementless long-stem hip prosthesis for treatment of femoral intertrochanteric fracture in the elderly.Methods:Retrospective analysis of 74 elderly patients treated for intertrochanteric fracture in the department of joint surgery at our hospital between January 2013 and June 2020.The 74 patients(15 men,59 women)were in the age range of 67–98 years(mean age,81.91±6.88 years).By the Evans–Jensen classification,there were 1 type I fractures,27 type II fractures,12 type III fractures,25 type IV fractures,and 9 type V fractures.47 cases were implanted with cement hemiarthroplasty,and 27 cases were implanted with cementless long-stem hip hemiarthroplasty.The bone cement group is divided into A1(unstable bone cement group)and A2(stable bone cement group).The cementless group is divided into group B1(unstable cementless group)and group B2(stable cementless group).Group B1 was divided into reconstruction group and non-reconstruction group according to whether proximal reconstruction was performed.Type I and II are stable.Type III,IV and V are unstable.Operation time,postoperative drainage,postoperative hospital stay,and postoperative complications were compared between the groups.The Harris Hip Score(HHS)was used to evaluate postoperative outcome.Results:Patients were followed up for periods ranging from 1 year to 7 years.74 patients included in the study,7 were lost to follow-up and 10 died in the last follow-up,and 57 patients were actually followed up.The cementless group was significantly better than the cement group in terms of operation time,intraoperative blood loss and postoperative hospital stay(P<0.05),which was statistically significant.There was no significant statistical difference between the unstable group A1 and the group B1 in terms of operation time,intraoperative blood loss and postoperative hospital stay.In the comparison between the stable group A2 and the group B2,the operation time of the group B2 was significantly shorter than that of the group A2(P<0.05),which was statistically significant.The average operation time and intraoperative blood loss of patients in the non-reconstruction group were significantly lower than those in the reconstruction group.There was no significant difference in Harris scores between the cementless group and the cement group,the stable group A1 and the group B1 at the last follow-up.Unstable group B1 is better than group A1 in function and total score(P<0.05).There was no statistical difference in pain and range of motion.Two patient in cementless group had dislocation after surgery;it was corrected by open reduction.One patient in cement group developed postoperative infections;however,he resolved within two weeks with antibiotic treatment and dressing changes.Conclusion:1.Cementless and prolonged hemiarthroplasty is better than cement hemiarthroplasty.2.Two-step osteotomy combined with cementless and prolonged hip prosthesis appears to be an effective treatment for intertrochanteric fractures in the elderly.