This document discusses recon hemi-arthroplasty surgery for intertrochanteric hip fractures in elderly patients with comorbid health issues. The surgery involves performing a basal osteotomy at the femoral neck to remove the head while retaining soft tissues around the fracture site. An uncemented prosthetic is then implanted to reconstruct the neck and stabilize the fracture. The procedure allows for early mobilization and physical therapy to prevent complications from prolonged bed rest. A study of 201 patients found recon hemi-arthroplasty had better survival rates and fewer postoperative issues than alternative surgical or conservative treatments.

1. Theme : 'Experience the Expertise'
Recon Hemi-Arthroplasty –
Solace in Inter Trochanteric Fractures of
Hip
in Morbid
Elderly
1st December 2018
Dr. V.S.N.Raju,
Consultant Orthopaedic Surgeon
Specialized in Hand & Microsurgery,
ARC Hospital, Hyderabad
Telangana, Bharat.
email : intacthands@gmail.com
Phone – 9348 227797, 9848 227797.

2. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Introduction:
Elderly with inter-trochanteric fractures of hip
are vulnerable, succumbing to co-morbid
conditions that risk life, if nursed in bed, though
operated upon.
Recon hemi-arthroplasty rated better over
other operative and conservative choices.

3. Objectives:
To operate upon inter-trochanteric fractures of
hip in elderly with high risk conditions using
modified hemi-arthroplasty to mobilize early.
Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Thus, post operative co-morbidities from
prolonged bed rest are overcome.

4. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Material:
201 patients, 61 male and 140 female, aged 75 to 99
years in the last 20 years with comminuted inter-
trochanteric fractures associated with age related co-
morbidities.
135 (42 male, 93 female) subjected to recon hemi
arthroplasty, 48 (13 male, 35 female) to dynamic hip
screw, 12 (3 male, 9 female) to conservative
management.
Fairer gender is more vulnerable !

5. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Method:
Basal osteotomy at neck of fractured femur helps enucleate and deliver the
head of femur retaining the inter-trochanteric area with fracture and/or
comminution, preserving its soft tissue.
1) Uncemented hemi arthroplasty is then completed thus impacting the
fractured inter-trochanteric area collared on to the stem of prosthesis.
2) When comminuted, the lesser trochanter is often lose and mobile, which
is impacted as calcar of femoral neck to maintain contour of neck in
reconstruction and length of limb preventing sinking on load.
3) A harness bolt or two across fenestration in the stem of implant avoids
collapse/sink of implant in porotic femora added to comminution.
Three varieties in Recon :

6. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Post Operative Course:
Early initiation of Physiotherapy possible .
Passive and active knee and ankle movements are
initiated on second and third post operative days,
respectively.
In most cases partial weight bear ambulation is
encouraged on 3rd day and full weight bearing with
support, as early as 15th day.

7. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Recon Hemi-Arthroplasty
Showing reconstruction
of Neck following
Basal Osteotomy of
Neck of Femur in
76 year old Female

8. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Results:
Clinically and statistically marked chances of survival,
an overall fall in complications from age related co-
morbid conditions and better compliance were
observed in cases operated with recon hemi
arthroplasty over other methods.
Survival rates were better.

9. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Conclusion:
Thus, this modified hemi-arthroplasty retaining majority
of comminuted neck, coined as reconstructive hemi-
arthroplasty edges over other modalities of treatment for
inter-trochanteric fractures of hip that demand longer
bed rest in treating elderly with co-morbid health
constraints.

10. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Routine / Contemporary Procedures :

11. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Routine / Contemporary Procedures :Continued.....

12. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Routine / Contemporary
Procedures :Continued.....

13. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Lesser Trochanter
plays a vital role

14. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
The Upper Fenestration
in the Stem Lodges
a Harness Screw to
Prevent Sink / Shortening

15. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
The Lower Fenestration
in the Stem Lodges
a Harness Screw to
Prevent Sink / Shortening

16. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Key Words: Arthroplasty, inter-trochanteric fracture
in elderly, co-morbid conditions, osteoporosis, high
risk, replacement, fracture of hip.
Message:
Ideal in centres operated by single surgeon,
especially in rural setups, without an ICU
support.
Attendants do not get frustrated in caring.

17. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
[PDF]Treatment of Intertrochanteric Hip Fractures in Elderly High Risk ...
https://juniperpublishers.com/oroaj/pdf/OROAJ.MS.ID.555606.pdf
by R Monreal - Related articles
Oct 17, 2016 - treatment in elderly high risk patients with intertrochanteric hip fractures for open surgery which offers a
low-risk operation with minimal blood loss, fast mobilization, few postoperative complications, and reduced cost
because of the short hospitalization.
Intertrochanteric fractures in elderly high risk patients treated with ...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911929/
by S Gangadharan - 2010 - Cited by 6 - Related articles
In patients with osteoporosis, any single type of internal fixation device cannot provide secure fixation of the fracture,
resulting in loss of the reduced position together with migration of the nails. Presently, intertrochanteric fractures are
fixed either with dynamic hip screw or proximal femoral nail.Abstract · INTRODUCTION · MATERIALS AND
METHODS · RESULTS
Intertrochanteric Hip Fractures Treatment & Management: Approach ...
https://emedicine.medscape.com/article/1247210-treatment
Feb 26, 2018 - Intertrochanteric fractures are considered 1 of the 3 types of hip ... in the elderly, have not been a
popular form of therapy for intertrochanteric ...
Treatment of intertrochanteric fractures in elderly highrisk patients - Injury
https://www.injuryjournal.com/article/S0020-1383(13)00555-X/abstract
by GH Kazemian - 2014 - Cited by 43 - Related articles
60 elderly high-risk patients with an average age of 78 years were treated for intertrochanteric fracture, resulting from a
low energy trauma. Patients were randomly divided in two groups regarding to treatment. In Group A the patients
were treated with DHS, while in Group B were treated with external fixator.
References :

18. Recon Hemi-Arthroplasty – Solace in Inter Trochanteric Fractures of Hip in Morbid
Elderly
Hip fracture in older patients: Tips and tools to speed recovery | The ...
https://www.mdedge.com/.../geriatrics/hip-fracture-older-patients-tips-and-tools-speed-re...
Hip fracture in a frail elderly patient is an injury that, while common, can be difficult to ... Intertrochanteric fractures can
be treated with either sliding hip screws Or such...
Intertrochanteric Fracture: Treatment, Recovery, and More – Healthline
https://www.healthline.com/health/intertrochanteric-fracture
Aug 2, 2017 - An intertrochanteric fracture is a common hip fracture that happens most often in older adults. It usually
requires surgery and months of physical therapy.
Management of trochanteric Fractures Babhulkar SS - Indian J Orthop
www.ijoonline.com/article.asp?issn=0019-5413;year=2006;volume=40;... - Cited by 44 - Related articles
The goal of treatment of any intertrochanteric fracture in the elderly is to restore mobility safely and efficiently while
minimizing the risk of medical complications ...
Poor prognosis after surgery for intertrochanteric fracture in elderly
https://journals.lww.com/.../Poor_prognosis_after_surgery_for_intertrochanteric.63.aspx by J Zhang - 2017 -
Sep 1, 2017 - Choice of surgical approach in patients under clopidogrel treatment is controversial. Intertrochanteric
fractures are common in the elderly, who ...
Elderly Hip Fracture – A Place for Momhttps://www.aplaceformom.com › Planning & Advice › Senior Living Articles
TREATMENT: SURGERY FOR HIP FRACTURES IN THE ELDERLY ... system used in intertrochanteric fractures, although the
recovery period is much longer.
Elderly patient's mortality and morbidity following trochanteric fracture ...
https://www.sciencedirect.com/science/article/pii/S1877056809001327 by H Mnif - 2009 - Cited by 45 - Related articles
Prevention consists in detecting and treating osteoporosis and countering the .... inter-trochanteric and complex
pertrochanteric fractures (p = 0.014; Table 3).
References : Continued..

19. Theme : 'Experience the Expertise'
Recon Hemi-Arthroplasty –
Solace in Inter Trochanteric Fractures of
Hip
in Morbid Elderly
1st December 2018
Dr. V.S.N.Raju,
Consultant Orthopaedic Surgeon
Specialized in Hand & Microsurgery,
ARC Hospital, Hyderabad
Telangana, Bharat.
email : intacthands@gmail.com
Phone – 9348 227797, 9848 227797.
Thank You !

20. IOACON 2018
& All of You !!