Quality of Life Following Treatment of Trochanteric Fractures with Proximal Femoral Nail versus Cementless Bipolar Hemiarthroplasty in Elderly

Desteli, Engin Eren; İmren, Yunus; Erdoğan, Murat; Aydagün, Özlem

doi:10.25011/cim.v38i1.22577

Cited by 39 publications

(54 citation statements)

References 44 publications

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“…3). However, the result of sensitive analysis by excluding the outlier study [11] did not alter significance, suggesting the result reliable.…”

Section: Resultsmentioning

confidence: 95%

“…The quality of the RCTs was acceptable, all the RCTs had reported their methods of randomization. Two RCTs [10,11] were conducted through the computer-generated list, and the remaining through a sealed opaque equivalent envelope. [12] None of the included RCTs reported blinding of the surgeons, participants, or assessors, though 1 study mentioned that the randomization list was concealed from the surgeon.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [10,11,18] reported data of hospital stay. There were a total of 287 patients, with 139 patients in IMF group and 148 in arthroplasty group.…”

Section: Resultsmentioning

confidence: 99%

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Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Nie

Yang

et al. 2017

Medicine

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Background:More and more studies conduct to compare intramedullary fixation (IMF) with arthroplasty in treating intertrochanteric hip fractures, but it remains controversy. The aim of this meta-analysis was to find out whether IMF or arthroplasty was more appropriate for treating intertrochanteric hip fractures in elderly patients.Methods:Relevant studies were searched in the electronic databases of PubMed, Embase, and The Cochrane Central Register of Controlled Trials from January 1980 to September 2016 with English language restriction. Surgical information and postoperative outcomes were analyzed using RevMan 5.3 version.Results:A total of 1239 patients from 11 studies which satisfied the eligibility criteria were included. Compared with IMF, the use of arthroplasty reduced implant-related complications (odds ratio [OR]: 2.05, P = .02) and reoperation rate (OR: 7.06, P < .001), and had similar length of hospital stay (weighted mean difference [WMD]: −0.41, P = .63). However, IMF reduced blood loss (WMD: −375.01, P = .001) and transfusion requirement (OR: 0.07, P < .001), shorter operation time (WMD: −18.92, P = .010), higher Harris hip score (WMD: 4.19, P < .001), and lower rate of 1-year mortality (OR: 0.67, P = .02) compared with arthroplasty.Conclusion:The main treatment of intertrochanteric hip fractures is internal fixation using IMF. In the absence of concrete evidence, arthroplasty should be undertaken with caution in carefully selected patient and surgeon should be aware of the increased complexity of doing the arthroplasty in these elderly patients. Further high-quality randomized controlled trials (RCTs) are needed to provide robust evidence and evaluate the treatment options.

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“…3). However, the result of sensitive analysis by excluding the outlier study [11] did not alter significance, suggesting the result reliable.…”

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

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Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Nie

Yang

et al. 2017

Medicine

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“…The follow‐up time ranged from 3 to 48 months. A comprehensive characteristic of the trials included in this meta‐analysis were reported in Table .…”

Section: Resultsmentioning

confidence: 99%

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

Zhang

Jiang

2019

Orthopaedic Surgery

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ObjectiveTo evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients.MethodsRandomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data.ResultsFourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta‐analysis. The methodological quality of the included study was poor. The meta‐analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD ‐14.61, 95% CI −21.51 to −7.7, P < 0.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, P < 0.0001), and post‐operative complications (OR 0.46, 95% CI 0.22 to 0.93, P = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, P < 0.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, P = 0.28), units of blood transfusion (WMD 0.34, 95% CI ‐0.16 to 0.85, P = 0.18), length of hospital stay (WMD ‐1.00, 95% CI ‐2.93 to 0.93, P = 0.31), Harris hip score (WMD 0.31, 95% CI ‐0.39 to 1.01, P = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, P = 0.86).ConclusionsThis systematic review and meta‐analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias.

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“…A total of 774 IF and 814 AR cases with ITFs in the elderly from 14 studies were included. Seven studies were from the Asia (China Chang,Shen,Tang,Yang , South Korea Kim,Kim,Park ), [25][26][27][28][29][30][31] 6 studies were from the Europe (Turkey Kayali, Görmeli, Desteli, Özkayın, Güven , France Bonnevialle ), [32][33][34][35][36][37] and 1 study was from Africa Gashi . 38 Among these eligible trials, the AR included hemiarthroplasty and total hip arthroplasty, the IF included intramedullary system (GN, PFN, PFNA, IN) and extramedullary system (CHS, DHS), which represented the commonly used implants in clinical practice.…”

Section: Literature Searchmentioning

confidence: 99%

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Yu¹,

Lu²,

Xiao³

et al. 2020

Preprint

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Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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Quality of Life Following Treatment of Trochanteric Fractures with Proximal Femoral Nail versus Cementless Bipolar Hemiarthroplasty in Elderly

Cited by 39 publications

References 44 publications

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

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