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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparative efficacy of cementless bipolar hemiarthroplasty and proximal femoral nail anti-rotation in unstable intertrochanteric fractures: A meta-analysis
Ahmed Mohamed Yousif Mohamed, Monzir Salih, Mugahid Mohamed, Ayman E Abbas, Maysara Elsiddig, Moaz Osama Omar, Mazin Abdelsalam, Basil Elhag, Nujud Mohamed, Souzan Hassan Eisa Ahmed, Samah Ahmed, Duaa Mohamed, Deena Omar
Ahmed Mohamed Yousif Mohamed, Nujud Mohamed, Department of Orthopaedic, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Monzir Salih, Saint Luke’s Radiation Oncology Network, St Luke’s Hospital, Dublin D06 HH36, Ireland
Mugahid Mohamed, Maysara Elsiddig, Mazin Abdelsalam, Basil Elhag, Department of General Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Ayman E Abbas, Department of Plastic Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Moaz Osama Omar, Faculty of Medicine, Ras al-Khaimah Medical and Health Sciences University, Ras al-Khaimah 11172, United Arab Emirates
Souzan Hassan Eisa Ahmed, Deena Omar, Department of Emergency, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Samah Ahmed, Duaa Mohamed, Faculty of Medicine, Gezira University, Wad Medani 9GQH+GWW, Sudan
Co-first authors: Ahmed Mohamed Yousif Mohamed and Monzir Salih.
Author contributions: Yousif Mohamed AM and Salih M jointly led the meta-analysis, conceptualized the study, designed the research methodology, and developed the search strategy. They supervised the systematic review process, conducted data extraction, performed statistical analysis and synthesis, and prepared the initial manuscript draft; Mohamed M, Abbas AE, Elsiddig M, Abdelsalam M, and Ahmed S executed the comprehensive literature search, screened and selected studies, extracted relevant data, and cross-validated the data for accuracy; Omar MO, Elhag B, and Mohamed N managed reference organization, manuscript formatting, and the preparation of figures and tables; Omar D, Ahmed S, and Mohamed D interpreted the results, conducted quality assessments, provided critical methodological revisions, and drafted the introduction and discussion sections, while also contributing to the quality assessment of included studies; All authors participated in reviewing, editing, and approving the final version of the manuscript for publication.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Duaa Mohamed, Faculty of Medicine, Gezira University, University of Gezira St, Wad Medani 9GQH+GWW, Sudan.
duaatom3@gmail.com
Received: April 2, 2025
Revised: April 18, 2025
Accepted: May 27, 2025
Published online: July 18, 2025
Processing time: 107 Days and 3.7 Hours
BACKGROUND
Unstable intertrochanteric fractures in elderly patients require effective surgical management, with both cementless bipolar hemiarthroplasty (CBHA) and proximal femoral nail anti-rotation (PFNA) being valid treatment options to reduce morbidity and mortality.
AIM
To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.
METHODS
A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures. Studies published up to January 1, 2025 were searched across multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar. Full texts of the selected articles were retrieved, reviewed, and independently assessed by the investigators. Discrepancies were resolved by consensus, with any remaining disagreements being arbitrated by a third author.
RESULTS
This meta-analysis included three studies, all of which were retrospective, involving a total of 240 patients. The follow-up period for participants was at least 12 months. CBHA was associated with significantly higher blood loss compared to PFNA [mean differences (MD): 129.14, 95%CI (52.51, 205.77), P = 0.001], though heterogeneity was high (I² = 97%). Operative time showed no significant difference initially [MD: 6.10, 95%CI (-13.34, 25.54), P = 0.54], but after excluding one study, BHA had longer operative times [MD: 21.51, 95%CI (18.60, 24.41), P < 0.00001]. Hospital stay and Harris scores showed no significant differences between groups. CBHA facilitated faster progression to weight-bearing [MD: -11.92, 95%CI (-22.46, -1.39), P = 0.03] and a lower incidence of prosthetic loosening [risk ratio: 0.21, 95%CI (0.05, 0.92), P = 0.04]. Refracture and thrombus formation rates were comparable between the two groups.
CONCLUSION
CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA. Both techniques show comparable functional recovery, hospital stay, refracture, and thrombus risks. Clinical choice should prioritize early mobilization or surgical minimalism, guided by patient needs. Further prospective studies are warranted.
Core Tip: This meta-analysis compares cementless bipolar hemiarthroplasty (CBHA) and proximal femoral nail anti-rotation (PFNA) for unstable intertrochanteric fractures. CBHA enables earlier weight-bearing and reduces prosthetic loosening but results in greater blood loss and longer operative times than PFNA. Both approaches show similar functional recovery, hospital stays, and complication rates (refracture/thrombosis). The choice between CBHA (optimal for early mobilization) and PFNA (preferred for minimal invasiveness) should be individualized based on patient factors. Prospective studies are needed to refine selection criteria.
