Undisplaced or minimal displaced medial neck femoral fractures are treated with canulated screws either in young or in elderly patients with good functional capacity, without severe comorbidity and cognitive impairment. We also perform this procedure in patients with very low daily activities and affected by severe comorbidity, with the aim to reduce pain. We reserve total hip replacement in middle-advanced age, with good level of functional activity and adequate bone-stock. We use bipolar hemiarthroplasty in patients that need early mobilization for the presence of comorbidities that could worsen. We prefer cemented bipolar hemiarthroplasty, as it gives an optimal primary stability, without press-fit. We prefer to utilize bipolar hemiarthroplasty with memory shape stem F.G.L. (Fig.1) in high risk patients (ASA classification). In fact the use of cement prolongs duration of surgery and is associated with higher perioperative mortality from cardiopulmonary complications. This stem in its metaphyseal region has 10 tabs, made of a Nitinol alloy (Ni-Ti). The feature of this alloy is to enlarge when brought to a certain temperature. When F.G.L. stem is mantained at 4° - 7° C the Nitinol (r) tabs are in the “restrained” configuration. Just at the time of surgery procedure, the stem is taken out of the refrigerator and inserted into the femoral diaphysis. At corporeal temperature, the Nitinol tabs enlarge, compressing the metaphyseal cancellous femoral region and give an immediate primary stability. We report clinical and radiological results of 15 patients (mean follow-up: 8 months) that underwent surgical procedure of bipolar hemiarthroplasty with F.G.L. stem in our department from March 2008 to December 2009. We had no perioperative complications and the results overlapped those of patients that underwent standard cemented bipolar hemiarthroplasty. The advantage of the use of F.G.L. stem is that it allows an immediate primary stability without searching an extreme press-fit. The disadvantage is the higher cost respect a standard cemented bipolar hemiarthroplasty. Therefore its use should be limited to those patients in which the surgery time must be contained for severe comorbidity, or in patients in which specific cardio-pulmonary complaints make dangerous the use of cement.

The Hipstar cementless system (Stryker) is a straight, wedge-shaped with a rectangular cross-section, titaniumalloy (TMZF) femoral component. This particular titaniumalloy (titanium, molybdeno, zirconium and iron) makes the stem 20% more resistant and less elastic than TiAlV alloy. The advantages are: a thinner neck with an equal resistant, an increase of range of motion, a reduction of impingement.

We examined 100 consecutive primary THRs between January 2002 and March 2004. The mean age was 69,9. Preoperative evaluation included a physical and radiographic examination. The acetabular component was the Trident cup (Stryker). Clinically, all the 100 hips were evaluated according to the scoring system of Harris. A patient’s evaluation test (WOMAC test) was also performed. At the time of the latest follow-up, standardized antero-posterior and axial radiographs of the pelvis and hip were made and evaluated according to Engh radiographic score. The median duration of follow-up was 24 months.

The median post-operative Harris Hip Score for 100 hips was 90.5. The observed mean value of WOMAC test score was 5,11. At the time of the latest follow-up, there was a bony incorporation of all components. We have had 2 cases of dislocation. At the latest follow-up no evidences of infection are present.

Aims: The pourpose of this study is to review a series of A2 intertrochanteric fractures in old, obese osteoporotic patients treated by total hip arthroplasty. Methods: 52 patients with A2 intertrochanteric fracture aged ≥ 75 years, mentally healthy, with BMD lower than 2.5 T score and Body Mass Index ≥30 were selected. They were 40 female and 12 males, aged 82±5 years with Body Mass Index of 32±2. Through a Hardinge approach to the hip, the femoral head was removed and a cemented cup and stem were implanted. Then the greater trochanter fragments were fixed by cerclage. The lesser trochanter fragment was not fixed. Medius gluteus muscle fibers were sutured to the greater trochanter and to the vastus lateralis muscle. All patients were allowed weight bearing as soon as possible after surgery. Results: No surgical complications were observed. Average Harris Hip Score at 1 month was 63±9 at 3 months 77±6 and at 1 year 78±7, at 5 years follow up 76±14 in the 24 patients still alive. None of the other died for causes related to the interthrocanteric fracture. Average return to normal daily activity time was 27±5 days. Conclusions: Total hip arthroplasty is a safe procedure for treatment of old, obese osteoporotic patients affected by A2 intertro-chanteric fractures. In fact, no failure occurred in any of the patients allowed unrestricted weight bearing from the first day after surgery. Moreover, they could return to normal daily activity in less than 5 weeks.