Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly A meta-analysis

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.