Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta-Analysis

Abstract

Objective: To evaluate the clinical efficacy of internal fixation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly.

Methods: A search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases up to April 2020. The present study compared internal fixation and hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. RevMan5.3 software provided by the International Cochrane Group was used for the meta-analysis. To compare the differences in the operation time, intraoperative bleeding, length of hospital stay, superficial infection, Harris hip score, mortality within 1 year, mortality within 2 years, reoperation, incidence of deep venous thrombosis (DVT), partial weight-bearing time, non-union, and implant-related complications between an internal fixation group and an hemiarthroplasty group.

Results: A total of 1300 patients were included in nine studies. The results showed that the operation time (MD = -18.09, 95% CI: -27.85--8.34, P = 0.0003), intraoperative bleeding (MD = -195.31, 95% CI: -244.8--147.74, P < 0.0001), implant-related complications (MD = 3.83, 95% CI: 1.74-8.45, P = 0.0008), and partial weight-bearing time (MD = 17.21, 95% CI: 1.63-32.79, P = 0.03) have statistical significance. However, there is not statistical significance for the Harris hip joint function scale (HHS) (MD = 5.60, 95% CI: -1.13-12.33, P = 0.10), DVT (MD = 1.02, 95% CI: 0.45-2.27, P = 0.97), length of hospital stay (MD = -1.08, 95% CI: -2.82-0.66, P = 0.22), superficial Infection (OR = 0.92, 95% CI: 0.43-1.98, P = 0.89), mortality within 1 year (OR = 0.95, 95% CI: 0.61-1.48, P = 0.81), mortality within 2 years (OR = 0.93, 95% CI: 0.61-1.43, P = 0.75), reoperation (MD = 1.80, 95% CI: 0.64-5.04, P = 0.26), and non-union (OR = 1.20, 95% CI: 0.48-3.03, P = 0.70). The result of the subgroup analysis showed no significant differences between the less than 2 years follow-up and the 2 years or more follow-up group. The only difference was for the Harris hip score: the internal fixation group was superior to the hemiarthroplasty group in the less than 2 years subgroup analysis, while there was no difference between the internal fixation group hemiarthroplasty group in the 2 years or more subgroup analysis.

Conclusion: Compared with the internal fixation group, those in the hemiarthroplasty group could carry out weight-bearing training early and implant-related complications were reduced, but it requires longer operation time and there is greater intraoperative blood loss. There is no difference in mortality, the incidence of DVT, non-union, HHS, reoperation, length of hospital stay, and superficial infection. Hemiarthroplasty may be a better choice for unstable intertrochanteric fractures in the elderly.

Keywords: Elderly; Hemiarthroplasty; Hip fractures; Internal fixators; Meta-analysis.

Fig 1

Preferred reporting items for systematic reviews and meta‐analyses flow diagram of study selection.

Fig 2

Risk of bias assessment summary of randomized controlled trials.

Fig 3

Forest plot diagram of intraoperative bleeding volume compared between internal fixation and hemiarthroplasty.

Fig 4

Forest plot diagram of operation time compared between internal fixation and hemiarthroplasty.

Fig 5

Forest plot diagram of the length of hospital stay compared between internal fixation and hemiarthroplasty.

Fig 6

Forest plot diagram of compared Harris hip joint function scale between internal fixation and hemiarthroplasty.

Fig 7

Forest plot diagram of compared partial weight‐bearing between internal fixation and hemiarthroplasty.

Fig 8

Forest plot diagram of compared mortality within 1 year between internal fixation and hemiarthroplasty.

Fig 9

Forest plot diagram of compared mortality within 2 years between internal fixation and hemiarthroplasty.

Fig 10

Forest plot diagram of compared reoperation between internal fixation and hemiarthroplasty.

Fig 11

Forest plot diagram of compared implant‐related complications between internal fixation and hemiarthroplasty.

Fig 12

Forest plot diagram of compared deep venous thrombosis between internal fixation and hemiarthroplasty.

Fig 13

Forest plot diagram of compared superficial infection between internal fixation and hemiarthroplasty.

Fig 14

Forest plot diagram of compared non‐union between internal fixation and hemiarthroplasty.