Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.107950
Revised: April 18, 2025
Accepted: May 27, 2025
Published online: July 18, 2025
Processing time: 107 Days and 3.7 Hours
Unstable intertrochanteric fractures in elderly patients require effective surgical management, with both cementless bipolar hemiarthroplasty (CBHA) and pro
To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.
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.
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.
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.