Arthroplasty for Pertrochanteric Hip Fractures

The mainstay of treatment of pertrochanteric fractures is internal fixation using a sliding hip screw or a cephalomedullary device. However, in patients with ipsilateral hip osteoarthritis or avascular necrosis of the femoral head, or inflammatory arthritis, arthroplasty should be considered as the primary treatment modality to reduce the likelihood of a secondary procedure. Unstable fracture patterns with concomitant poor bone quality represent a challenge for internal fixation, with high rates of lag screw cut-out and hardware failure. Prosthetic replacement for unstable pertrochanteric fractures has therefore been considered as an alternative primary treatment option. Further prospective randomized trials are required.