PRIMARY CEMENTED HEMIARTHROPLASTY VERSUS PROXIMAL FEMORAL NAIL ANTI-ROTATION FOR UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY OSTEOPOROTIC PATIENTS: WHICH ONE IS BETTER?

Ji Wang, Zhihong Tang, Hao Sun, Jianghong Yang, Yong yue^*

Department of Orthopaedics, No. 967 Hospital of the PLA Joint Logistics Support Force, 116021 Dalian, Liaoning Province, China

Objective: The purpose of this study was to compare the clinical effects between Primary cemented hemiarthroplasty (PCHA) and Proximal femoral nail anti-rotation (PFNA) for unstable intertrochanteric hip fractures in elderly osteoporotic patients.

Methods: There were 122 patients with intertrochanteric hip fractures from January 2017 to June 2019 who were included in this retrospective study. In total, 62 patients underwent Proximal femoral nail anti-rotation (PFNA group), while the other 60 patients underwent Primary cemented hemiarthroplasty (PCHA group). Outcome assessments included Perioperative information (such as the incision length, intraoperative bleeding, operation time, hospitalization time), complications, reoperations, and Harris hip score (HHS) were collected at follow-up 24 months.

Results: The incision length, operation time, intraoperative blood loss, and hospitalization time in the PFNA group were better than those in the PCHA group (P<0.05). During the 24months follow-up, the total incidence of postoperative complications in the PFNA group was 30.64%, higher than 20% in the PCHA group (P>0.05). The reoperation rate of PCHA group (1/60, 1.67%) was significantly lower than that of PFNA group (7/62,11.3%) (P<0.05). The HHS in the PCHA group at 6 weeks, 3 and 6 months after operation was higher than that in the PFNA group (P<0.05). There was no significant difference in hip function between the PFNA and PCHA groups, with a 12-month HHS (86.19±6.53 vs 85.27±5.47; P>0.05). At follow-up, PFNA group showed better Hip function (HHS) than PCHA group (86.23±10.42 vs 82.15±10.53, P<0.05).

Conclusion: Both procedures are effective methods for the treatment of unstable intertrochanteric fractures in the elderly. PCHA might be a good choice for the treatment of elderly osteoporotic patients with unstable intertrochanteric hip fractures in terms of lower reoperation and better function recovery in the early stage.