Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis

Yoo, Jun Il; Ha, Yong‐Chan; Lim, Jae‐Young; Kang, Hyun; Yoon, Byung‐Ho; Kim, Hyunho

doi:10.3346/jkms.2017.32.5.858

Cited by 42 publications

(41 citation statements)

References 26 publications

(64 reference statements)

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“…Consistent with previous results, [ 19 , 20 ] we also found that PFNA has shorter duration of operation time and less blood loss during surgery than BPH, which implies that PFNA does less surgical injury to patients. However, different from the hypothesis that longer bed-ridden leads to a high rate of general complications, our data incidence of complications 2 weeks after operation in Group A is much lower than Group B.…”

Section: Discussionsupporting

confidence: 93%

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

Tan¹,

Shi

Zhang

et al. 2020

Medicine

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This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more. This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared. There are no statistically significant differences when compared general data in patients from group A and B ( P > .05). Operation time in Group A is less than Group B (103.33, 40–230 min vs 122.64, 75–180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50–100 mL vs 194.44, 100–500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7–100 days vs 6.67, 4–14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0–91 points vs 64.41, 0–90 points, P > .05). Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.

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Section: Discussionsupporting

confidence: 93%

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

Tan¹,

Shi

Zhang

et al. 2020

Medicine

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“…Similar with published data 14 , in this study, we also find that PFNA and BPH have similar functional outcome, which means in the term of functional recovery, either PFNA or BPH is accepted for elderly ITFs patients. Consistent with previous results 17,18 , we also found that PFNA has shorter duration of operation time and less blood loss during surgery than BPH, which implies that PFNA does less surgical injury to patients. However, different from the hypothesis that longer bed-ridden (time of weight bearing after operation in Group A is 47.96 ± 31.16 days longer than 10.68 ± 21.36 days in Group B) leads to a high rate of general complications, our data demonstrated that incidence of bad complications two weeks after operation in Group A is much lower than Group B.…”

Section: Acute Cerebral Infarctionsupporting

confidence: 92%

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

Huang

Shi

Pan

et al. 2020

Sci Rep

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intertrochanteric fractures (itfs) in the elderly are still a big challenge for clinical doctors. Although proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) are selected by most of the orthopaedic surgeons for elderly ITFs patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in elderly. In this study, we hypothesized that BPH should not be selected as the primary option for ITFs in elderly patients, and analyzed clinical data of 202 elderly ITFs patients aged 80 years or more treated with PFNA (Group A) and BPH (Group B) to compare the early outcome of PFNA and BPH for ITFs in elderly patients aged 80 years or more. We found that operation time and blood loss during surgery in group A are less than in Group B. Time of weight bearing after operation in Group A is longer than in Group B. Incidence of complications 2 weeks after operation in Group A is 9.29% less than 25.81% in Group B (χ 2 = 9.539, p = 0.002). Mortality rates 12 months after operation in Group A is 11.43% similar with 19.35% in Group B (χ 2 = 2.261, p = 0.133). Harris Hip Score 12 months after operation in Group A is 68.00 ± 29.11 points similar with 65.73 ± 33.29 points in Group B (t = 0.490, p = 0.625). Therefore, for elderly ITFs patients aged 80 years or more, BPH should not be selected as the primary option for itfs in elderly patients.

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“…This is consistent with previous reports. 48,49 In contrast to the incidence of general complications after surgery, our results showed that the complications-related operation and rate of reoperation of the AR group are better than that of the IF group. A total of ten articles compared the complications-related operation of the two groups.…”

Section: Postoperative Complications and Reoperationcontrasting

confidence: 57%

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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Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis

Cited by 42 publications

References 26 publications

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

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

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