Abstract
Purpose: A prospective multicentric study was conducted in a concentric and consecutive series of 204 patients operated on between Mai 1999 and August 2001 for fracture of the proximal femur. The purpose of this study was to assess quality of life after surgery in patients undergoing implantation of the Intermedia® prosthesis.
Material and methods: Mean patient age was 79.6± 8.6 years), 18.8% men. Most of the fractures were Garden III and IV fractures (87.4%) and 90.9% were recent (< 21 d). The intermediary Intermedia® prosthesis was implanted via the posterolateral approach in 73.9% of the patients with acetabular preparation in 13.7%; a head with a restraining skirt was used in 20.8%. The Robinson score for motion, lifestyle, degree of osteoporosis (Singh score), history (ASA), psychomotor index (Hodkinson score) were determined preoperatively (19/26 (±6.89). The Merle d’Aubigné score was calculated at one year. Adaptation of the femoal stem (3 sizes) to the shaft was assessed on standard x-rays. The Kobayashi method was used to study stem to shaft fit; this score gives a rate of shaft filling used to determine whether the self-blocking contact was well achieved with the three stem sizes available.
Results: There were eleven (5.4%) posterior dislocations including four which were reduced orthopaedically. Among the 203 patients, 40 (19.7%) were lost to follow-up and 34 died. The Merle d’Aubigné score at one year showed 84.7% satisfactory results (excellent, very good, good). Preoperatively 59% of the patients were independent and 7% resided in nursing homes, these figures at one year were 55.5% and 5% respectively. Radiologically, the rate of migration (impaction) was 3.9% at one year. Stem-to-shaft fit was, according to Kobayashi for the proximal, middle, and distal portions 73%, 75% and 75% respectively.
Discussion: Mortality due to fracture of the proximal femur is high (16.7% at one year). Morbidity was due to infection (1%) and eleven displacements (5.4%). The difference in motion and lifestyle between the pre- and postoperative period was not significant. Simplification of the implantation procedure by using three stem sizes did not produce any radiological differences at one year.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
