Published: 2017-01-02

Randomized controlled analysis-autogenous bone peg graft improved offset hemiarthroplasty in high risk patients: a novel cost effective technique

Hashmukh Shantilal Varma, Sachin Upadhyay, Nuthan Jagadeesh


Background: Femoral neck fractures in elderly with comorbidities are a serious and increasing challenge. Surgery remains the mainstay of treatment for early rehabilitation. In present Indian scenario, the two major factors that drive our strategy for treatment are affordability and use of cemented prosthesis in high risk patients. The primary objective is to develop a technique that not only maintains the hip biomechanics after arthroplasty but also cost-effective.

Methods: Fifty high risk elderly patients of either sex with fracture neck femur after randomization were divided into two groups. Hemiarthroplasty through postero-lateral approach was done .Unipolar prosthesis were used in both the groups. A new measurement “X” was defined. Radiologically correlation between the value of ‘X’ and the variation in femoral offset is measured with novel technique and compared the parameters with conventional technique. P<0.05 was considered significant.

Results: In patients with novel technique value of X was 1 mm±0.8 SD, whereas value of X in conventional technique the value of X was significantly higher of about 7.2 mm±1.6 SD and this was associated with increased femoral off set 47.2±2.0 SD and the correlation was found to be statistically significant (p<0.05). Furthermore, in group B where graft was not used subsidence was found in 6 patients (24%). None was revised during the period of follow up.

Conclusions: Our preliminary results indicate that the approach proposed is feasible and effective in the management of intracapsular fracture neck femur in high risk patients with unipolar prosthesis.



Fracture neck femur, Hemiarthroplasty, Unipolar prosthesis

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Dai Z, Li Y, Jiang D. Meta-analysis comparing arthroplasty with internal fixation for displaced femoral neck fracture in the elderly. J Surg Res. 20011;165(1):68-74.

Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J. 2004;429:43-8.

Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age- which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16.

Donaldson AJ, Thomson HE, Harper NJ, Kenny NW, Bone cement implantation syndrome. Br. J. Anaesth. 2009;102(1):12-22.

Devane PA, Horne JC. Assessment of polyethylene wear in total hip replacement. Clin Orthop Relat Res. 1999;369:59-72.

Steinberg B, Harris WH. The and Idaquo: offset and rdaquo: problem in total hip arthroplasty. Contemp Orthop. 1992;24(5):556-62.

Parker MI, Pryor G, Gurusamy K. Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures. Bone and Joint J. 2010;92(1):116-22.

Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000;371:206-15.

Tyllianakis M, Panagopoulos A, Papadopoulos A, Papasimos S, Mousafiris K. Treatment of extracapsular hip fractures with the proximal femoral nail : long term results in 45 patients. Acta Orthop Belg. 2004;70:444-54.

Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989;71:1214–25.