The Journal of Bone and Joint Surgery (American). 2005;87:2186-2192.
doi:10.2106/JBJS.D.02768
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Cementless Calcar-Replacement Hemiarthroplasty Compared with Intramedullary Fixation of Unstable Intertrochanteric Fractures

A Prospective, Randomized Study

Shin-Yoon Kim, MD1, Yong-Goo Kim, MD1 and Jun-Kyung Hwang, MD1

1 Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Jung Gu Sam Duck 2 Ga 50, Daegu 700-721, South Korea. E-mail address for S.-Y. Kim: syukim{at}knu.ac.kr

Investigation performed at the Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, South Korea

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Unstable intertrochanteric fractures in elderly patients are associated with a high rate of complications. The purpose of this investigation was to compare the results of long-stem cementless calcar-replacement hemiarthroplasty with those of treatment with a proximal femoral nail for unstable intertrochanteric fractures in elderly patients.

Methods: Fifty-eight elderly patients with an AO/OTA type 31-A2 intertrochanteric fracture of the femur were randomized into two treatment groups and were followed for a minimum of two years. The twenty-nine patients in Group I were treated with a long-stem cementless calcar-replacement prosthesis, and the twenty-nine patients in Group II were treated with a proximal femoral nail. The two treatment groups were comparable with regard to demographic and injury variables.

Results: There were no significant differences between the groups in terms of functional outcomes, hospital stay, time to weight-bearing, or general complications. Patients treated with a proximal femoral nail had a shorter operative time, less blood loss, fewer units of blood transfused, a lower mortality rate, and lower hospital costs compared with those treated with the long-stem cementless calcar-replacement prosthesis.

Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture, a proximal femoral nail provides superior clinical outcomes but no advantage with regard to functional outcome when compared with a long-stem cementless calcar-replacement arthroplasty.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

Read all Letters to the Editor

Treatment of Unstable Intertrochanteric Fractures
Oguz Cebesoy, et al.
JBJS Online, 7 Dec 2005 [Full text]
Dr. Kim, et al, reply to Dr. Cebesoy, et al
Shin-Yoon Kim, et al.
JBJS Online, 4 Jan 2006 [Full text]