Surgical Research
Open AccessPrimary Arthroplasty for Unstable Peritrochanteric Fractures in the Very Old: A Two Patient Illustrative Series and Evidence Informed Rationale
Authors: Chi-Ming Chiang.
Abstract
Background: In very old patients with osteoporotic, unstable peritrochanteric fractures, the optimal index surgery remains debated. While cephalomedullary nailing is guideline?recommended for many unstable patterns, early full?weight bearing after primary arthroplasty may shorten recumbency in the frailest patients. We report two illustrative patients (ages 78 and 95 years) treated with primary arthroplasty and synthesize contemporary evidence.
Methods: Both patients presented with AO/OTA 31?A2/A3 morphology and severe osteopenia on radiographs. One underwent total hip arthroplasty (THA) and one bipolar hemiarthroplasty through a posterolateral approach. Early mobilization protocols targeted chair?standing on day 1 and supervised ambulation by day 2. Radiographic endpoints were restoration of offset, leg length, and stable implant position; clinical endpoints were pain control and safe transfer/ambulation.
Results: Immediate postoperative films demonstrated stable component positioning and restoration of hip center in both cases (Figures 2–4). Both patients mobilized with protected weight bearing within 48 hours, without early mechanical failure. Conclusions: In selected very old patients with poor bone quality and unstable peritrochanteric patterns, primary arthroplasty can be a pragmatic, time?efficient pathway to early mobilization. Contemporary trials and meta?analyses suggest that while cephalomedullary nails remain standard care, hemiarthroplasty yields comparable hip scores with fewer cut?out events at the expense of higher superficial infection risk. Evidence for cement augmentation of nails is mixed. These cases illustrate an evidence?informed rationale for individualized arthroplasty when fixation would not plausibly allow immediate full weight bearing.
Editor-in-Chief
View full editorial board →