Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients.

One hundred independently mobile patients over the age of 75 who had an unstable intertrochanteric or subtrochanteric fracture were treated with primary prosthetic replacement. In all patients a cemented femoral component with diaphyseal support was used. A bipolar arthroplasty was performed in 91 patients and a total hip arthroplasty in 9 patients because of associated coxarthrosis. The functional results according to the Merle d'Aubigné hip rating scale were excellent, very good or good in 78% of the hips. The dislocation rate of 44.5% in the patient group who underwent total hip arthroplasty was significantly higher than the 3.3% in those who had bipolar arthroplasty. Associated with the dislocations was a much higher incidence of pressure sores and pulmonary complications. Adverse effects on the femoral side included 4 cases with progressive loosening of the screws used to fix the greater trochanter to the femoral component, 1 fracture of the distal femur and 1 pseudarthrosis of the bone envelope surrounding the femoral component.