Management of Hip Arthroplasty for Intertrochanteric Fractures Under the Treatment Concept of Periprosthetic Fractures.

Abstract

Objective: Intertrochanteric fractures (IF) in the elderly are often complicated by osteoporosis and high rates of fixation failure. Current treatment options have limitations in providing both stable fixation and early mobilization in this fragile population. This study aimed to introduce and evaluate a novel approach, the periprosthetic femoral fracture treatment concept (PFFtc), as a surgical strategy to guide hip arthroplasty in elderly IF patients.

Methods: A retrospective analysis was conducted on 209 elderly patients (mean age: 81.6 years; range: 70-93) with IF who underwent hip arthroplasty using the PFFtc protocol between March 2014 and August 2021, comprising 133 females and 76 males. All patients underwent treatment with the "PFFtc" and were subsequently followed up at intervals of 1 month, 3 months, 6 months, 1 year, 2 years, and annually thereafter. Clinical parameters such as ASA anesthesia grading, Visual Analogue Scale (VAS) scores, Harris Hip Scores (HHS), and Short-Form 36 (SF-36) outcomes were meticulously recorded. The subsidence of the femoral stem was assessed using Pelligrini's method, while mortality rates, postoperative complications, and patient's survival status post-discharge were systematically documented. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative complications.

Results: Over a mean follow-up of 38.5 ± 6.0 months, prosthesis subsidence averaged 2.2 mm and stabilized. No deaths occurred within 30 days postoperatively. The 1- and 2-year cumulative mortality rates were 4.3% and 11%, respectively. The most common complications included DVT and urinary tract infections. Logistic regression identified hypoproteinemia (OR = 2.38, p = 0.032) and heart disease (OR = 2.74, p = 0.012) as independent risk factors for postoperative complications. At final follow-up, the mean VAS was 1.1 ± 1.0, HHS was 89.4 ± 3.9, PCS was 53.2 ± 8.5, and MCS was 50.5 ± 6.7. Among surviving patients, 63.0% lived independently at home.

Conclusion: The PFFtc-guided arthroplasty approach appears to be a safe and effective option for managing IF in elderly patients. It provides stable fixation and functional recovery of prostheses and muscles and offers a promising alternative to traditional fixation strategies.