The Use of a Cementless Modular Stem in the Treatment of Subtrochanteric Femoral Fractures in Conjunction with Ipsilateral Coxarthrosis

Subtrochanteric fractures of the femur below an arthritic hip are uncommon and challenging to orthopedic surgeons. Most of these fractures occur in elderly patients with advanced osteoporosis. The treatment choices consist of treatment of the fracture and the above hip joint versus treatment of the fracture alone. This study evaluates the clinical and radiological outcomes of arthroplasties performed to treat both conditions in a single surgery with the use of a cementless modular revision stem. Twelve subtrochanteric femoral fractures of 12 patients (9 women, 3 men) with a mean age of 76.4 years (range, 62-88 years) were treated with cementless modular revision stems. Total hip arthroplasty was performed with cementless femoral and acetabular component fixation. All hips received the same femoral and acetabular implants. All patients had comorbidities and the average American Society of Anesthesiologists score was 2.3 (range, 1-3). Ten of the 12 hips (83%) required an assistance device for ambulation before the trauma. There were 2 Dorr Type A (17%), 3 Dorr type B (25%), and 7 Dorr type C (58%) femora. The mean postoperative Harris Hip Score was 83 (range, 72-92) with a mean follow-up of 4.3 years (range, 2-7 years). At final follow-up, 9 hips (75%) were ambulatory without support (P=.016). Ten hips (83%) were able to both ambulate and walk up and down stairs. Two hips (17%) were able to ambulate but could not climb and descend stairs. Union was achieved in all femora at an average of 22.3 weeks (range, 16-32 weeks). Radiographic findings demonstrated stable ingrowth of the femoral prosthesis with no evidence of subsidence in 11 hips (92%). The average Engh score for all femora was 20.2 (range, 10-26). There was no relationship between the bone morphology (Dorr type) of the femoral medullary canal and the bone ingrowth scores of Engh (P=.639).