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Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis
OBJECTIVE: To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients. METHODS: Randomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons Australia, Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819185/ https://www.ncbi.nlm.nih.gov/pubmed/31663280 http://dx.doi.org/10.1111/os.12532 |
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author | Ju, Jia‐bao Zhang, Pei‐xun Jiang, Bao‐guo |
author_facet | Ju, Jia‐bao Zhang, Pei‐xun Jiang, Bao‐guo |
author_sort | Ju, Jia‐bao |
collection | PubMed |
description | OBJECTIVE: To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients. METHODS: Randomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data. RESULTS: Fourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta‐analysis. The methodological quality of the included study was poor. The meta‐analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD ‐14.61, 95% CI −21.51 to −7.7, P < 0.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, P < 0.0001), and post‐operative complications (OR 0.46, 95% CI 0.22 to 0.93, P = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, P < 0.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, P = 0.28), units of blood transfusion (WMD 0.34, 95% CI ‐0.16 to 0.85, P = 0.18), length of hospital stay (WMD ‐1.00, 95% CI ‐2.93 to 0.93, P = 0.31), Harris hip score (WMD 0.31, 95% CI ‐0.39 to 1.01, P = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, P = 0.86). CONCLUSIONS: This systematic review and meta‐analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias. |
format | Online Article Text |
id | pubmed-6819185 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley & Sons Australia, Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-68191852019-11-04 Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis Ju, Jia‐bao Zhang, Pei‐xun Jiang, Bao‐guo Orthop Surg Review Articles OBJECTIVE: To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients. METHODS: Randomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data. RESULTS: Fourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta‐analysis. The methodological quality of the included study was poor. The meta‐analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD ‐14.61, 95% CI −21.51 to −7.7, P < 0.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, P < 0.0001), and post‐operative complications (OR 0.46, 95% CI 0.22 to 0.93, P = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, P < 0.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, P = 0.28), units of blood transfusion (WMD 0.34, 95% CI ‐0.16 to 0.85, P = 0.18), length of hospital stay (WMD ‐1.00, 95% CI ‐2.93 to 0.93, P = 0.31), Harris hip score (WMD 0.31, 95% CI ‐0.39 to 1.01, P = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, P = 0.86). CONCLUSIONS: This systematic review and meta‐analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias. John Wiley & Sons Australia, Ltd 2019-10-29 /pmc/articles/PMC6819185/ /pubmed/31663280 http://dx.doi.org/10.1111/os.12532 Text en © 2019 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Articles Ju, Jia‐bao Zhang, Pei‐xun Jiang, Bao‐guo Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis |
title | Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis |
title_full | Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis |
title_fullStr | Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis |
title_full_unstemmed | Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis |
title_short | Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis |
title_sort | hip replacement as alternative to intramedullary nail in elderly patients with unstable intertrochanteric fracture: a systematic review and meta‐analysis |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819185/ https://www.ncbi.nlm.nih.gov/pubmed/31663280 http://dx.doi.org/10.1111/os.12532 |
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