A comparison of hemiarthroplasty versus dynamic hip screw fixation for intertrochanteric femoral fractures: a systematic review

Abstract

Introduction: Intertrochanteric fractures are predominantly treated by dynamic hip screw (DHS) fixation. However, recent evidence has found acceptable clinical results following hemiarthroplasty for these fractures. Thus, a systematic review was conducted to compare hemiarthroplasty with DHS fixation for intertrochanteric fractures. Methods: A computerised search was performed, using the databases Medline, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials, with supplementation from Google Scholar and appropriate reference lists. Studies with comparative data comparing clinical outcomes of hemiarthroplasty versus DHS fixation were included. Data were extracted and quality assessment of the papers performed by 2 reviewers. Results: 320 articles were independently reviewed by the investigators. A total of 10 studies met the inclusion criteria, comprising 2 randomised controlled trials and 8 cohort designs. 7 of the studies assessed unstable fracture patterns. There was no difference in operating time (SMD −1.169 min; 95% CI, −0.657 to 0.689) or blood transfusion volume (SMD−0.110 units; 95% CI, −0.520 to 0.891) between modalities. There was also no difference in length of stay (SMD −0.778 days; 95% CI, −0.606 to 0.336), mortality (RR 0.942; 95% CI, 0.749–1.183) or major complications. Hemiarthroplasty conferred significantly better Harris Hip Scores at 12 months (SMD 12.3; 95% CI, 0.0135–2.789) and allowed earlier weight-bearing than DHS fixation. Discussion: Qualitative and quantitative compilation of the included studies demonstrates hemiarthroplasty to result in better functional scores and a quicker time to weight-bearing than DHS fixation for intertrochanteric fractures. Results are comparable for other major parameters, including operative time, length of stay and mortality. Thus, hemiarthroplasty is a suitable alternative to DHS fixation for unstable intertrochanteric fractures in elderly patients.

Functional Outcome of Hemiarthroplasty of the Hip for Unstable Intertrochanteric Fractures of the Femur in Elderly Patients: A Prospective Study

“…In this study, the mean time of full weight bearing was 5.36 ± 1.49 days, while in the studies by Sancheti et Hongku et al conducted a systematic review to compare the efficacy of osteosynthesis (dynamic hip screw, proximal femoral nail) and bipolar hemiarthroplasty and showed that dynamic hip screw and PFN had a significantly higher risk of operative failure compared with bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients [28]. Chowdhury et al did a systematic review to compare hemiarthroplasty and DHS fixation for intertrochanteric fractures in elderly patients [29]. They found that at 12 months, hemiarthroplasty led to significantly higher Harris Hip Scores and allowed patients to start bearing weight sooner than with DHS fixation.…”

Bilateral Femoral Neck Fractures in a 50-Year-Old Patient with Chronic Kidney Disease

“…Our choice of hemiarthroplasty as a surgical procedure was driven by multiple factors, including patient age, presence of CKD, delayed presentation, and the fact that hemiarthroplasty provides better functional outcomes and has a shorter time to weightbearing compared to other procedures, such as the dynamic hip screw [14]. In a cohort of more than 70 000 patients who underwent surgery for femoral neck fractures, Wang and Bhattacharya reported that 95% of patients underwent hemiarthroplasty.…”