Key result
Proximal femoral nail antirotation linked to ~64% fewer early complications versus bipolar hemiarthroplasty.
Why the study?
There is no consensus on the superiority of proximal femoral nail antirotation versus bipolar hemiarthroplasty for intertrochanteric fractures in elderly patients.
Does proximal femoral nail antirotation improve outcomes compared to bipolar hemiarthroplasty in elderly patients aged 80 years or more with intertrochanteric fractures?
Cohort (n=202)
Yes
Does proximal femoral nail antirotation improve outcomes compared to bipolar hemiarthroplasty in elderly patients aged 80 years or more with intertrochanteric fractures?
Absolute Event Rate: 25.81% vs 9.29%
p-value: p=0.002
In elderly patients aged 80 years or older with intertrochanteric fractures, PFNA is associated with fewer early complications compared to BPH, suggesting BPH should not be the primary option.
PFNA linked to less blood loss and early complications than BPH in elderly ITFs; leaves open need for RCTs to guide practice.
Intertrochanteric fractures (ITFs) in the elderly are still a big challenge for clinical doctors. Although proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) are selected by most of the orthopaedic surgeons for elderly ITFs patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in elderly. In this study, we hypothesized that BPH should not be selected as the primary option for ITFs in elderly patients, and analyzed clinical data of 202 elderly ITFs patients aged 80 years or more treated with PFNA (Group A) and BPH (Group B) to compare the early outcome of PFNA and BPH for ITFs in elderly patients aged 80 years or more. We found that operation time and blood loss during surgery in group A are less than in Group B. Time of weight bearing after operation in Group A is longer than in Group B. Incidence of complications 2 weeks after operation in Group A is 9.29% less than 25.81% in Group B (χ2 = 9.539, p = 0.002). Mortality rates 12 months after operation in Group A is 11.43% similar with 19.35% in Group B (χ2 = 2.261, p = 0.133). Harris Hip Score 12 months after operation in Group A is 68.00 ± 29.11 points similar with 65.73 ± 33.29 points in Group B (t = 0.490, p = 0.625). Therefore, for elderly ITFs patients aged 80 years or more, BPH should not be selected as the primary option for ITFs in elderly patients.
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Huang et al. (2020) conducted a cohort in Intertrochanteric fractures (n=202). Bipolar hemiarthroplasty (BPH) vs. Proximal femoral nail antirotation (PFNA) was evaluated on Incidence of complications 2 weeks after operation (p=0.002). Bipolar hemiarthroplasty was associated with a significantly higher incidence of complications 2 weeks after surgery (25.81%) compared to proximal femoral nail antirotation (9.29%) in elderly patients with intertrochanteric fractures.
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