Key result
Proximal femoral nail antirotation is linked to ~61% fewer early postoperative complications versus bipolar hemiarthroplasty.
Why the study?
The study was conducted to compare the early outcomes of proximal femoral nail antirotation versus bipolar hemiarthroplasty in elderly patients aged 85 years or older with intertrochanteric fractures.
Does proximal femoral nail antirotation improve outcomes compared to bipolar hemiarthroplasty in elderly patients aged 85 years or more with intertrochanteric fractures?
Cohort (n=120)
Does proximal femoral nail antirotation improve outcomes compared to bipolar hemiarthroplasty in elderly patients aged 85 years or more with intertrochanteric fractures?
Absolute Event Rate: 14.12% vs 36.11%
p-value: p=<0.01
Proximal femoral nail antirotation is associated with fewer postoperative complications, shorter operation time, and less blood loss compared to bipolar hemiarthroplasty in elderly patients with intertrochanteric fractures, despite similar 12-month mortality and functional outcomes.
This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more.This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared.There are no statistically significant differences when compared general data in patients from group A and B (P > .05). Operation time in Group A is less than Group B (103.33, 40-230 min vs 122.64, 75-180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50-100 mL vs 194.44, 100-500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7-100 days vs 6.67, 4-14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0-91 points vs 64.41, 0-90 points, P > .05).Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.
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Tan et al. (2020) conducted a cohort in intertrochanteric fractures (n=120). Proximal femoral nail antirotation (PFNA) vs. Bipolar hemiarthroplasty (BPH) was evaluated on incidence of complications 2 weeks after operation (p=<0.01). Proximal femoral nail antirotation was associated with fewer postoperative complications at 2 weeks compared to bipolar hemiarthroplasty (14.12% vs 36.11%, P<0.01) in patients aged ≥85 with ITFs.
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