[Prosthetic replacement for pathological fractures of the proximal end of the femur: total prosthesis or bipolar arthroplasty?].

INTRODUCTION

The purpose of this prospective study was to present our experience with bipolar or total hip arthroplasty in 28 consecutive cases of metastasis of the intertrochanteric and subtrochanteric area.

MATERIALS AND METHODS

Twenty-eight patients with metastatic involvement of the proximal femur underwent either bipolar or total hip arthroplasty. Proximal femoral resection and prosthetic replacement with a massive component was routinely performed.

RESULTS

The postoperative morbidity rates for dislocation and pressure sores were significantly lower (p < 0.05) in the bipolar arthroplasty group. Postoperative pain relief according to Habermann was excellent in 81.5 per cent and good in 14.8 per cent of the patients. The functional results according to the hip rating scale of Merle d'Aubigné were rated as excellent in 19 per cent, very good in 22 per cent and good in 22 per cent of the hips. The prognosis for survival was superior in patients with a preoperative Karnofsky performance status index of more than 60 points (p < 0.01) and in patients without postoperative pulmonary complications (p < 0.01). New bone formation around the femoral prosthetic component occurred in 11 (61 per cent) of the 18 patients surviving three months or longer. This bone formation did not affect the clinical results. In the current series pain relief as well as postoperative walking ability were comparable in both groups but the dislocation rate was significantly lower (p < 0.05) with bipolar arthroplasty.

CONCLUSION

We recommend bipolar arthroplasty rather than total hip arthroplasty in patients with a preoperative Karnofsky performance status index of more than 60 points if bone disease of the acetabulum is not evident on standard radiographs and if during operation the acetabular cartilage appears normal.