Key result
Hemiarthroplasty shows no benefit over proximal femoral nails for Harris hip scores in unstable pertrochanteric fractures.
Why the study?
Although proximal femoral nails are well-established for unstable pertrochanteric fractures, some reports suggest hemiarthroplasty provides superior benefits, requiring a direct comparison to guide surgical decision-making.
Does hemiarthroplasty improve outcomes compared to proximal femoral nails in patients with unstable pertrochanteric fractures?
Systematic Review (n=2,517)
Does hemiarthroplasty improve outcomes compared to proximal femoral nails in patients with unstable pertrochanteric fractures?
Effect estimate: MD -1.73 points (95% CI -6.27 to 2.80)
p-value: p=0.45
Hemiarthroplasty and proximal femoral nails are both effective for unstable pertrochanteric fractures with no clinically important differences in final functional outcomes, suggesting internal fixation should be prioritized unless hemiarthroplasty is essential.
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Prioritizes nail fixation unless hemiarthroplasty is essential; reinforces equivalent long-term functional outcomes.
Background Pertrochanteric fractures are common and challenging for surgeons, especially in unstable conditions. Proximal femoral nails or nails anti-rotation variants are well-established surgical instruments to treat this, but some reports suggest that in unstable situations, hemiarthroplasty provides superior benefits to patients. This study aimed to compare hemiarthroplasty with proximal femoral nails, highlighting the differences to assist surgical decision-making. Methods Online databases were searched for eligible studies in accordance with PRISMA guidelines. Results were analyzed across 18 domains, categorized into three branches: function, complication, and perioperative condition and mortality. Effect sizes were calculated, and the heterogeneities thereof were analyzed. We also tested sensitivity, publication biases, and graded certainty of evidence. Finally, comprehensive results were interpreted. Results Twenty-seven studies, with a total of 2,517 patients, were included. The hemiarthroplasty performed better than nails in early Harris hip scores, full weight-bearing time, and complication rate related to implants. Proximal femoral nails performed better in terms of surgery duration and superficial infection. No significant differences were observed in final Harris hip scores, general and implant-unrelated complications, mortality, hospital stay, re-operation incidence, bedsores, and deep venous thrombosis. Ambulation time, blood loss, and transfusion incidence showed potential publication bias. Conclusion Hemiarthroplasty and proximal femoral nails/nails anti-rotation are effective methods for treating unstable pertrochanteric fractures. No clinically important differences—such as re-operation rates due to implant-related complications—were identified between these two tactics. Surgeons should prioritize internal fixations, barring conditions wherein hemiarthroplasty is essential.
Zhang et al. (2026) conducted a systematic review in Senile patients (typically aged 70-80s) with unstable pertrochanteric fractures (n=2,517). Hemiarthroplasty vs. Proximal femoral nail or proximal femoral nail anti-rotation (PFN/PFNA) fixation was evaluated on Final Harris hip score after more than 6 months post-surgery (MD -1.73 points, 95% CI -6.27 to 2.80, p=0.45). Hemiarthroplasty showed no statistically significant difference in final Harris hip scores compared to proximal femoral nail fixation in patients with unstable pertrochanteric fractures (MD -1.73, 95% CI -6.27 to 2.80, p=0.45).
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