Fixation distale par tige modulaire sans ciment sans reconstruction du calcar dans les fractures pertrochantériennes instables chez les patients de plus de 75 ans

Abstract Introduction Hemiarthroplasty (HA) using standard-length femoral stem with reconstruction of femoral calcar or using calcar-replacing prosthesis for unstable intertrochanteric fractures in elderly patients is a viable option. However, both of the techniques increase the complexity of procedure, operative trauma and complication. This study evaluated the clinicoradiological results of the MP-Link cementless distal fixation modular prosthesis without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more. Hypothesis Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, do not need to reconstruct the femoral calcar. Materials and Methods Forty-two patients (42 hips) underwent bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures from January 2008 to January 2012. Five (11.9 %) patients were lost to follow-up. The 37 remaining patients (37 hips) were available for evaluation. The mean age was 83.9 ± 5.2 years. Their clinicoradiological data were prospectively gathered. Results All of 37 patients, 4 patients (10.8 %) died within 1 year postoperatively. At the final follow-up, 31 (83.8 %) out of 37 patients were regained preoperative ambulatory status; the mean Harris hip score (HHS) of the 15 patients who died during the follow-up period of 7–59 months, was 84.5 ± 2.4 points; the 22 healthy patients were followed for 68.6 ± 14.7 months, with mean HHS of 84.6 ± 2.8 points. Radiologically, none of stems had evidence of loosening; 16 stems had subsidence of 2–3 mm without clinical significance; the bone ingrowth fixation was achieved in 24 patients and stable fibrous fixation in 13 patients. Discussion Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, without reconstruction of the femoral calcar, may achieve a satisfactory clinicoradiological outcome, and could regain preoperative ambulatory status in most patients (83.3 %). Level of Evidence IV, Retrospective study.