Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies

Abstract

Introduction To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma. Methods PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores. Results A total of four RCT’s (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1–0.7). The occurrence of device/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1–0.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1–0.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3–12.9). Radiological scores (lag screw/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15°, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0–0.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4–1.3) and cement related complications were rare. Conclusion Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.

[Retracted] Clinical Analysis of Surgical Treatment of Senile Intertrochanteric Fracture Based on Intelligent Knowledge of Health Care

“…And it can also illustrate the above views; preoperative intelligent health care knowledge can reduce the psychological burden of patients. It can help patients get out of bed early and move around and shorten the bed time [ 11 ]. In addition, there were no significant difference in postoperative complications between the two groups, but the infection rate of the study group was slightly lower than that of the control group; hence, in this analysis, the authors' speculation may be due to two groups of patients who use surgery the same way, so the postoperative complications contrast will not have a too big difference, but the team in preoperative intelligent health care knowledge training, compared with the control group, have a more detailed understanding of what behaviors may cause infection by pulling the wound after surgery, so they pay more attention to these aspects, resulting in a lower wound infection rate [ 12 ].…”

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

“…†In the scenario analysis, higher rates of revision surgery (1.6% for augmentation and 7.4% for no augmentation) were assumed in the decision tree model. These rates were based on the meta-analysis by Rompen et al 45 .…”

“…The scenario analysis attempted to generate a more generalizable estimate by assuming higher rates of revision surgery. These rates were obtained from a meta-analysis comparing cement augmentation with no augmentation during fixation of low-energy trochanteric fractures in patients >65 years old 45 . Although these rates were observed in cases implanted with a PFNA as well as other intramedullary nails, they potentially captured the more general effect of cement augmentation versus no augmentation.…”

“…Therefore, the base-case analysis may represent a conservative cost-effectiveness estimate. In order to model potential outcomes from centers with diverse levels of surgeon skill and experience, a scenario analysis was conducted by assuming higher probabilities of revision surgery in the decision tree model on the basis of the recent meta-analysis by Rompen et al 45 . The probabilities of revision surgery for fixation with augmentation and without augmentation were assumed to be 1.6% and 7.4% (p = 0.009), respectively.…”

Augmentation in fragility fractures, bone of contention: a systematic review

“…When using cement, fragility fractures have a lower complication rate than total joint replacement, as the cement is injected at a lower pressure [20]. Furthermore, among the potential benefits of augmentation, lower re-intervention rates and a reduction in total hospital stay have been observed [21].…”