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Primary arthroplasty as a method of choice for the treatment of pertrochanteric fractures in elderly and senile patient

Background. The primary endoprosthesis is used as an alternative to internal osteosynthesis in osteoporotic pertrochanteric fractures in the elderly and senile patients. However, there are controversial views of surgeons on a choice of indications, surgical approach, the technique of reconstruction of the trochanteric region, the technique of implantation of the femoral component, and the surgical injury. The purpose of the work is to substantiate our own approach to primary arthroplasty in pertrochanteric and intertrochanteric fractures in elderly and senile patients from the standpoint of assessing the immediate and medium-term outcomes. Materials and methods. In the period from 2015 to 2019, primary arthroplasty was performed in 44 patients. The age of patients ranged from 72 to 89 years (mean age 77.34 ± 2.10 years). Under the classification of AO, 13 fractures were of type 31-A1, 25 — 31-A2, 6 — 31-A3. Results. Before implantation of the femoral stem, the trochanteric space and calcar were reconstructed. There were no complications associated with reconstruction and implantation of an endoprosthesis. The duration of surgery ranged from 50 minutes to 1 hour 20 minutes. The average intraoperative blood loss was 280 ± 60 ml. The duration of the inpatient period ranged from 6 to 11 days (on average, 8.3 ± 2.6 days). Clinical and radiological results were studied in 32 (72.72 %) patients within 4–14 months. Control radiography confirmed reparative processes in the area of reconstruction, satisfactory bone density around the cement mantle, and the stem of the endoprosthesis. The results of the survey demonstrated that the restored functional activity corresponded to the level before the injury. Conclusions. An overall assessment of the anatomical and functional results confirms the expediency of using primary arthroplasty as an alternative method for treating osteoporotic trochanteric fractures.