Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9878-9888
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9878
Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: A systematic review and meta-analysis
Wen-Huan Chen, Wen-Xuan Guo, Shi-Hua Gao, Qiu-Shi Wei, Zi-Qi Li, Wei He
Wen-Huan Chen, The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Wen-Xuan Guo, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Shi-Hua Gao, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Qiu-Shi Wei, Zi-Qi Li, Wei He, Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Author contributions: Chen WH contributed to study conception and design, drafting the submitted article; He W, Wei QS and Li ZQ revised the draft critically for important intellectual content; Guo WX and Gao SH contributed to acquisition, analysis, and interpretation the data; and all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei He, MD, Professor, Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261 Longxi Road, Liwan District, Guangzhou 510405, Guangdong Province, China. hw13802516062@126.com
Received: June 18, 2021
Peer-review started: June 18, 2021
First decision: August 18, 2021
Revised: August 27, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 16, 2021
Processing time: 144 Days and 14.6 Hours
ARTICLE HIGHLIGHTS
Research background

Proximal femoral nails (PFNs) and arthroplasty are common methods for the treatment of intertrochanteric femoral fractures (IFFs), but there is no consensus on which treatment is better for elderly patients with unstable fractures.

Research motivation

At present, many retrospective studies have compared and analyzed the clinical efficacy of arthroplasty and PFNs in the treatment of unstable IFFs, but the results differed. To explore whether arthroplasty can really replace PFNs as the preferred treatment, we conducted this study.

Research objectives

To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients and determine whether arthroplasty can replace traditional PFNs.

Research methods

Through meta-analysis and systematic review, we summarized the randomized controlled trials (RCTs) in the past 20 years. According to the inclusion and exclusion criteria, the results of four RCTs were finally included for analysis. According to the data given in the literature, the Harris Hip Score (HHS), mortality, complications, blood loss, operation time and hospital stay, weight-bearing walking time and anesthesia of the two methods were analyzed and compared.

Research results

The joint replacement group had earlier weight-bearing walking time and shorter hospital stay, but the HHS, bleeding volume and operation time in the PFN group were better. There were no significant differences in mortality, complications and anesthesia between the two groups.

Research conclusions

Based on available evidence, arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly patients.

Research perspectives

More high-quality clinical studies are needed to judge whether joint replacement can replace PFNs as the first choice for the treatment of unstable IFFs in elderly patients.