Study on the risk and countermeasures of contralateral hip refracture after different surgical methods in the treatment of osteoporotic hip fracture in the elderly

ObjectiveTo study the risk and countermeasures of contralateral hip refracture after proximal femoral nail anti-rotation(PFNA) and artificial femoral head replacement(FHR) in the treatment of osteoporotic hip fracture in the elderly.

MethodsThe clnical data of 71 patients aged more than 75 years old with omminuted intertrochanteric fracture of the femur were retrospectively analyzed.The pateints were divided inton the PFNA group(52 cases) and FHR group(19 cases) according to the different surgical methods.The relative clinical indexes, Harris functional score of the hip joint at different postoperative stages, bone mineral density of the contralateral hip and incidence rate of refracture of the contralateral hip were compared between two groups.

ResultsThe length of incision, operative time, intraoperative blood loss, length of hospital stay and hospitalization cost in PFNA group were less than those in FHR group, and the postoperative weight-bearing time in PFNA group was longer than that in FHR group(P < 0.05 to P < 0.01).The Harris scores in FHR group after 1 and 3 months of operation were higher than those in PFNA group(P < 0.05), and there was no statistical significannce in the Harris scores between two groups after 6 and 12 months of surgery(P>0.05).The results of repeated ANOVA showed that the differences of the time of bone mineral density in contralateral hip change and interactions of surgical modalities between two groups were statistically significant after operation(P < 0.01).Comparing two groups at the same time, the changes in the bone mineral density of the opposite hip bone after surgery in the PFNA group were lower than those in the FHR group(P < 0.05 to P < 0.01).

ConclusionsThe bone mineral density levels in postoperative patients treated with PFNA and FHR are low, the continuous safety protection and management of osteoporosis after osteoporotic fractures should be emphasized.FHR is more conducive to reduce the risk of refracture of the contralateral hip in patients with severe osteoporosis.