Cementless calcar-replacement stem with integrated greater trochanter plate for unstable intertrochanteric fracture in very elderly patients

Purpose: To evaluate the clinical results of rigid fixation of the greater trochanter fragment through a consecutive hemiarthroplasty series using a cementless and modular calcar-replacement prosthesis with an integrated plate (MOD-Centaur stem) with 1-year follow-up in very elderly patients with unstable intertrochanteric fractures.Methods: We assessed 44 consecutive very elderly patients (age >85 years; 2 men, 42 women; mean age at surgery: 89.6 years) with an unstable intertrochanteric fracture who underwent bipolar hemiarthroplasty using the MOD-Centaur stem by the same surgeon. Operative time and blood loss were evaluated, and postoperative complications and mortality rate within 1 year were assessed. Bony union of the greater trochanter was evaluated using plain X-ray images at least 6 months postoperatively. Walking ability was evaluated at the time of discharge and at 1 year postoperatively.Results: The mean operative time was 95.8 min, and the mean intraoperative blood loss was 358.0 mL. Postoperative peripheral infection occurred in one patient. Four patients died within 1 year postoperatively (mortality rate: 9.1%). Bony union of the greater trochanter was achieved in all the patients who had a plain X-ray taken at least 6 months postoperatively. At 1-year follow-up, 20 patients could walk independently.Conclusion: Hemiarthroplasty using the MOD-Centaur stem for unstable intertrochanteric fracture in very elderly patients offers favorable outcomes. These findings encourage early walking without any loading limitations, despite severe osteoporosis, and emphasize the importance of greater trochanteric fixation, which reconstructs the mechanism of the gluteus medius muscle.