Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9878
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
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.
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.
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.
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.
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.
Based on available evidence, arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly patients.
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.