Hip arthroplasty versus proximal femoral nail antirotation for intertrochanteric fractures in older adults: A meta-analysis

Junming CHEN

ABSTRACT

OBJECTIVE:

At present, it has become a consensus that elderly patients with femoral intertrochanteric fracture should be treated by surgery. The main surgical methods are hip arthroplasty and proximal femoral nail antirotation. There are many reports on the clinical effects of these two surgical methods, but which surgical treatment is the better choice under different conditions is still controversial. The clinical efficacy and safety of hip arthroplasty and proximal femoral nail antirotation in the treatment of intertrochanteric fractures in the elderly were evaluated by meta-analysis.

METHODS:

The databases of PubMed, Cochrane Library, Embase, CNKI, Wanfang and VIP were searched to screen and compare the clinical randomized controlled trials of hip arthroplasty and proximal femoral nail antirotation in the treatment of elderly femoral intertrochanteric fractures from 2000 to 2020. The quality of the research was evaluated independently according to the evaluation tools recommended by the Cochrane system evaluator manual 5.3. Operation time, intraoperative blood loss, hospital stay, first weight bearing time, postoperative Harris function score, postoperative orthopedic complications and postoperative medical complications were selected as evaluation indexes. According to the results, the forest plot was drawn by RevMan 5.3 software, and the data were analyzed.

RESULTS:

After screening, a total of eight articles were included, containing three English articles and five Chinese articles, all of which were clinical randomized controlled trials. There were 8 articles of grade B, including 716 patients. The results of meta-analysis showed that the operation time of the proximal femoral nail antirotation group was shorter (WMD=15.48, 95%CI7.78-23.19, P < 0.05), the intraoperative blood loss was less (WMD=104.61, 95%CI58.86-150.36, P < 0.05), and the initial weight-bearing time of the hip arthroplasty group was shorter (WMD=-12.16, 95%CI-18.68 to-5.63; P < 0.05). There was no significant difference in postoperative average hospital stay, Harris function score, postoperative orthopedic complications and postoperative medical complications.

CONCLUSION:

For elderly patients with intertrochanteric fracture, artificial hip arthroplasty can accelerate the functional recovery of hip joint, shorten the time of bed rest, and enable patients to carry out weight-bearing exercise in the early stage. With the continuous progress of artificial hip arthroplasty and the development of minimally invasive technology, the trauma caused by operation is getting smaller and smaller. Under the premise of strengthening perioperative management (such as strengthening preoperative preparation and postoperative management, shortening operation time, reducing bleeding, and actively dealing with basic diseases), compared with proximal femoral nail antirotation, hip arthroplasty has more advantages in the treatment of femoral intertrochanteric fractures in the elderly.