Abstract:

OBJECTIVE: To compare artificial femoral head replacement and internal fixation in treating elderly intertrochanteric fractures, and explore the indications.

METHODS: A computer-based online search was performed for articles published between January 1969 and October 2009 with the key words “hip replacement, intertrochanteric fractures, internal fixations” in English. Articles related with biomaterials and tissue engineered materials were included. Repetitive studies or Meta analysis were excluded. A total of 10 articles were discussed. A total of 168 patients, aged over 75 years, were selected from Department of Orthopedics, Second Hospital of Dalian Medical University and treated with artificial femoral head replacement and internal fixation. The operation time, bleeding, postoperative complications, bed stay duration, hip functional recovery, and hospitalization duration were compared.

RESULTS: Elderly intertrochanteric fractures have been majorly treated by internal fixation. It remains controversial whether artificial femoral head replacement is necessary. Currently, artificial hip prosthesis materials include cobalt alloy and titanium alloy, polyethylene, porous polysulfones, acetal resinoid, and carbon. The internal fixation patterns include cement-typed prosthesis, biotype prosthesis, their combination, and modern cement technique. Clinical results show that artificial femoral head replacement displayed advantages in operation time, postoperative complications, bed stay duration, and hospitalization duration compared with internal fixation (P < 0.05). The hip functional recovery was superior to internal fixation at 1, 3, and 6 months postoperatively (P < 0.05), but no differences were observed at 12 months postoperatively (P > 0.05).

CONCLUSION: Artificial femoral head replacement has advantages of early postoperative recovery, early weight loading and few complications in treating elderly intertrochanteric fractures compared with the internal fixation. However, the long-term complications require further observation.