Comparison of Quality of Life between Fixation and Arthroplasty in Intertrochanteric Fracture of Femur in Elderly Patients

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Yodsawee Pornmeechai
Thanathep Tanpowpong

Abstract

Background: Standard treatment for intertrochanteric fracture is internal fixation. Arthroplasty is an alternative treatment for these fractures in some specific conditions. Apart from hip functional score, health-related quality of life (HRQoL) is one of the interesting domains that can reflect the outcome of the treatment. However there are many conditions affecting HRQoL especially in the elderly patients.


Objective: To evaluate the HRQoL of the patients between treatment of intertrochanteric fracture in elderly with fixation and arthroplasty.


Materials and Methods: In this retrospective study, 143 intertrochanteric fracture patients who were treated during 2001-2015 were included. The patients were divided into 2 groups; 82 patients in fixation group and 61 patients in arthroplasty group. HRQoL between 2 groups were compared by EuroQol-5D-5L(EQ-5D-5L) index score at 3, 6 and 12 months postoperatively.


Results: The mean of EQ-5D-5L index score was significantly better in arthroplasty group  than fixation group at 3 months (0.8 vs 0.6)(P < 0.05) and 6 months (0.91 vs 0.78)(P < 0.05) postoperatively. However, there was no significant difference at 12 months (0.94 vs 0.87)(P = 0.15).


Conclusion: Arthroplasty in intertrochanteric fracture in elderly might give better quality of life than fixation in the early postoperative period. 

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References

1. Wongtriratanachai P, Luevitoonvechkij S, Songpatanasilp T, Sribunditkul S, Leerapun T, Phadungkiat S, et al. Increasing incidence of hip fracture in Chiang Mai, Thailand. J Clin Densitom 2013; 16: 347-52.
2. Rojanasthien S, Luevitoonvechkij S. Epidemiology of hip fracture in Chiang Mai. J Med Assoc Thai 2005; 88 Suppl 5: S105-9.
3. Jongjit J, Komsopapong L, Songjakkaew P, Kongsakon R. Health-related quality of life after hip fracture in the elderly community-dwelling. Southeast Asian J Trop Med Public Health 2003; 34: 670-4.
4. Shyu YI, Chen MC, Liang J, Lu JF, Wu CC, Su JY. Changes in quality of life among elderly patients with hip fracture in Taiwan. Osteoporos Int 2004; 15: 95-102.
5. Akan K, Cift H, Ozkan K, Eceviz E, Tasyikan L, Eren A.. Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail. J Int Med Res 2011; 39: 857-65.
6. Chang Q, Liu S, Guan C, Yu F, Wu S, Jiang C. Bipolar hip arthroplasty. J Arthroplasty 2011; 26: 1455-9.
7. Emami M, Manafi A, Hashemi B, Nemati A, Safari S. Comparison of intertrochanteric fracture fixation with dynamic hip screw and bipolar hemiarthroplasty techniques. Arch Bone Jt Surg 2013; 1: 14-7.
8. Tang P, Hu F, Shen J, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012; 43: 876-81.
9. Suriyawongpaisal P, Chariyalertsak S, Wanvarie S. Quality of life and functional status of patients with hip fractures in Thailand. Southeast Asian J Trop Med Public Health 2003; 34: 427-32.
10. Brooks R. EuroQol: the current state of play. Health Policy 1996; 37: 53-72.
11. Kimman M, Vathesatogkit P, Woodward M, Tai ES, Thumboo J, Yamwong S, et al. Validity of the Thai EQ-5D in an occupational population in Thailand. Qual Life Res 2013; 22: 1499-506.
12. Singh S, Shrivastava C, Kumar S. Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur. J Clin Diagn Res 2014; 8: LC01-LC04.
13. Kim Y, Moon JK, Hwang KT, Choi IY, Kim YH. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians. Acta Orthop Traumatol Turc 2014; 48: 424-30.
14. Kumar Gn K, Meena S, Kumar NV, S M, Raj Mk V. Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: a prospective study. J Clin Diagn Res 2013; 7: 1669-71.
15. Karthik K, Natarajan M. Unstable trochanteric fractures in elderly osteoporotic patients: role of primary hemiarthroplasty. Orthop Surg 2012; 4: 89-93.
16. Choy WS, Ahn JH, Ko JH, Kam BS, Lee DH. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Clin Orthop Surg 2010; 2: 221-6.
17. Sinno K, Sakr M, Girard J, Khatib H. The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients. N Am J Med Sci 2010; 2: 561-8.
18. Bonnevialle P, Saragaglia D, Ehlinger M, Tonetti J, Maisse N, Adam P, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res 2011; 97: S95-100.
19. Shen J, Wang DL, Chen GX, Yang HL, Li L, Wei MX, et al. Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients. J Orthop Sci 2012; 17: 722-9.