Chen WH, Guo WX, Gao SH, Wei QS, Li ZQ, He W. Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: A systematic review and meta-analysis. World J Clin Cases 2021; 9(32): 9878-9888 [PMID: 34877326 DOI: 10.12998/wjcc.v9.i32.9878]
Corresponding Author of This Article
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
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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
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.
