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Hemiarthroplasty - an Innovative Method*Savyasachi Thakkar - Joints Masters Institute and Johns Hopkins University - Baltimore, USAK.T. Rajshekhar - Joints Masters Institute - Mumbai, IndiaChandrashekhar Thakkar - Joints Masters Institute - Mumbai, India*Email: savya@jhmi.eduIntroduction: Management of unstable comminuted intertrochanteric fractures with cementedbipolar hemiarthroplasty in elderly patients with osteoporosis is an established method whichallows early mobilization. However in intertrochanteric fractures, the medial calcar support islacking. We have devised a method of using bone from the calcar as a graft, with cementedbipolar hemiarthroplasty [Fig.1]. This graft serves quadruple purposes – (1) it fills the medialcalcar void, (2) it prevents settling of the prosthesis in varus and retroversion (3) it gives cue tolimb length equalization and (4) it restores abductor tension due to restoration of limb length[Fig 2].Methods: Between 2005 and 2010, we treated 37 patients with intertrochanteric fractures usingthis technique. The selection criteria were - osteoporosis as judged on preoperative x-rays usingSingh’s index, unstable fractures according to Evans, and medical co-morbidities that requiredearly full weight-bearing mobilization. All patients were operated within 24 hours after theinjury. We analyzed the restoration of limb length (measured from the ipsilateral anteriorsuperior iliac spine to medial malleoli bilaterally) and studied the fate of bone graft (usingpostoperative radiographs at 6 months). We also analyzed postoperative complications andcompared surgical duration, requirement of blood transfusions, and hospital length of stay withvalues in the literature. Statistical significance was defined as p ≤ 0.05.Results: In one case, the graft sank during prosthesis insertion leading to limb shortening of1.5cm, while in 36 patients the limb lengths were equalized within 5 ± 1.2 mm. 18 patientsreported for follow-up - in 2 patients the graft was absorbed, while in16 patients the bone graftgot consolidated. Three patients had implant failures in the form of breakage of implant stem atjunction of upper 1/3 with lower 2/3. One patient had a painful nonunion of the greatertrochanter, while one patient had a superficial bed sore. One patient died the night of surgery.Our surgical duration was significantly shorter than a study which used cementless calcarreplacementhemiarthroplasty for the management of similar fractures (45 ± 12 minutes vs. 96 ±26 minutes; p