title: Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical and radiographic outcomes of bipolar hemiarthroplasty with cementless stem for the unstable intertrochanteric fracture in octogenarians and to determine the influencing factors associated with subsidence of the stem.
  
  
  METHODS
  The study included the 143 hips of 139 patients (119 females, 20 males). Mean follow-up period was 3.8 (range: 2.2 to 9.0) years. The displaced lesser trochanteric fragment was reduced anatomically and fixed with 16-gauge stainless steel cerclage wire. Clinical outcomes included Harris Hip Score (HHS), thigh pain, groin pain and walking ability. Radiographic outcomes included stem fixation and stability, osteolysis, heterotopic ossification and subsidence. The stable reduction group was determined when anatomic reduction of posteromedial fragments was achieved with ≤1 mm gap of fragment.
  
  
  RESULTS
  Mean HHS was 82 (range: 78 to 99) at the final follow-up. Thirty-one hips (21.7%) experienced thigh pain and 19 (13.3%) groin pain. One hundred and twelve patients (80.6%) regained their pre-injury level of ambulation. All femoral stems showed osseointegration without aseptic loosening and osteolysis. The mean stem subsidence was 3.1±2.4 (range: 0 to 18) mm. The extent of subsidence was significantly higher in patients with unstable reduction. The survival rate was 94.2%.
  
  
  CONCLUSIONS
  Cementless bipolar hemiarthroplasty appears to be a suitable method for the treatment of intertrochanteric fracture in octogenarians. However, stable fixation of the posteromedial fragment is necessary to avoid stem subsidence.
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Yeesuk
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Jun Ki
authors.initials: JK
authors.lastname: Moon
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Il Yong
authors.initials: IY
authors.lastname: Choi
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D062785:Hemiarthroplasty / Q000379:methods*; D006615:Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D016348:Osseointegration; D010024:Osteoporosis; D010146:Pain; D011474:Prosthesis Design; D011859:Radiography; D016896:Treatment Outcome; D016138:Walking