Is the proximal femoral nail antirotation better than hemiarthroplasty ? : A Meta-analysis involving 1283 elderly patients with unstable intertrochanteric fractures

BACKGROUND Surgical treatment is an accepted method for intertrochanteric fractures. For the older adults accompanied by severe osteoporosis and other diseases, how to treat intertrochanteric fractures still remains controversial. OBJECTIVE To evaluate the effectiveness and safety of proximal femoral nail antirotation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in older adults through meta-analysis. METHODS According to the Cochrane system evaluation, a computer-based retrieval of Medline、Pubmed、SPINGER、John Wiley、Science Direct、Elsevier、SAGE、EBSCO databases between 2000 and 2018 was performed. The keywords were “proximal femoral nail ant-irotation or PFNA, hemiarthroplasty, unstable intertrochanteric fractures” in English respectively. The literate was screened based on inclusion and exclusion criteria, and then quality evaluation was conducted. Meta-analysis was undergone on the Rev-Man 5.1. RUSULTS : (1) Twelve clinical trials were included, involving 1283 patients, and including 6 randomized controlled trials. (2) Meta-analysis results showed that the operation time in the proximal femoral nail antirotation group was shorter [MD=-17.02, 95%Cl(-29.64,-4.77), P < 0༎01], intraoperative blood loss was lower [MD=-216.91, 95༅CI(-269.84, -163.99), P < 0.01], hospitalization time was shorter [MD=-1.72, 95༅CI(-3.25, -0.19), P < 0.05], the postoperative in HSS was higher [MD = 4༎78, 95༅Cl(2.59, 6༎97), P < 0.01], excellent and good rate of postoperative HSS was better [RR = 1.54, 95༅Cl(1.09, 2.16, P < 0.05], compared with the hemiarthroplasty group. (3) In the hemiarthroplasty group, the ambulation time was earlier [MD = 4.8, 95༅CI(1.31, 8.29), P < 0.01], but the rate of mortality was higher [RR = 0.5, 95༅Cl༈0.36, 0.70, P < 0.01], compared with the proximal femoral nail antirotation group. (4) There was no significant difference between two groups in the postoperative Implant-related or medical complications, re-operation rates and infection rate (P > 0.05). CONCLUSION For the treatment of senile unstable intertrochanteric fractures, the proximal femoral anti-rotation intramedullary nailing is faster, less intraoperative bleeding, shorter hospital stay, better postoperative function and lower mortality, and its efficacy is better than that of hemiarthroplasty.