Key result
Hip replacement resulted in longer operative times (WMD 15.20) and greater intraoperative blood loss compared to PFNA, but allowed for a significantly shorter time to first weight-bearing in elderly patients with intertrochanteric fractures.
Why the study?
The study was conducted to evaluate the clinical efficacy and safety of hip replacement versus proximal femoral nail antirotation in treating intertrochanteric fractures in the elderly.
Does hip replacement improve clinical outcomes compared to PFNA in elderly patients with intertrochanteric fractures?
Meta-Analysis (n=1,374)
Does hip replacement improve clinical outcomes compared to PFNA in elderly patients with intertrochanteric fractures?
While PFNA is associated with shorter operative time and less blood loss, hip replacement allows for earlier weight-bearing in elderly patients with intertrochanteric fractures, with no significant difference in complications.
May support earlier mobilization with HR in select elderly patients; leaves open need for RCTs to guide implant choice over PFNA.
BACKGROUND: The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. METHODS: We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed. RESULTS: After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups. CONCLUSION: With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.
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Chen et al. (2021) conducted a meta-analysis in Intertrochanteric fractures (n=1,374). Hip replacement vs. Proximal femoral nail antirotation (PFNA) was evaluated on Operative time (WMD 15.20, 95% CI 13.17-17.23, p=<0.0001). Hip replacement resulted in longer operative times (WMD 15.20) and greater intraoperative blood loss compared to PFNA, but allowed for a significantly shorter time to first weight-bearing in elderly patients with intertrochanteric fractures.
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