Treatment Of Unstable Intertrochanteric Fractures In Elderly Patients With Hip Arthroplasty Or Dynamic Hip Screw: A Meta-Analysis

Objective: To evaluate the efficacy and safety of treatment for unstableintertrochanteric fractures in elderly patients with hip arthroplasty or dynamic hip screw.Method: Studies on comparison between hip arthroplasty and dynamic hip screw in thepast20years were identified from Medline, PubMed, Embase, Cochrane Library, CBM,CNKI, Articles Digital Periodicals. And relevant Chinese and English Orthopaedics andnearly five years of domestic and international orthopedic conference papers werehandsearched. The literatures according with the inclusion criteria were assessed by tworeviewers using a modified Jadad score sheet and the quality evaluation method. Anddisagreements were resolved through discussion and negotiation. All the randomizedcontrolled trials(RCTs) included for meta-analysis were analysed with RevMan5.1software. Results: Seven prospective randomized studies(RCTs) involving3in English,4in Chinese were identified. There were682cases, of which339patients (256cases of HA,83cases of THA)in hip arthroplasty group,343cases in DHS group. The results ofmeta-analysis indicated that there were statistical difference between two groups onintraoperative blood loss(WMD=106.16,95%CI:26.31~186.02, P=0.009), bed time aftersurgery(WMD=-36.83,95%CI:-40.60~-33.05, P＜0.00001), hospital stay(WMD=-5.71,95%CI:-9.82~-1.60, P=0.006), incidence of postoperative complications(OR=0.27,95%CI:0.16~0.45, P＜0.00001), incidence of secondary surgery(OR=0.14,95%CI:0.04~0.49,P=0.002). While there were no statistical differences between two groups onoperative time(WMD=9.35,95%CI:0.01~18.69, P=0.05) and postoperative1-yearmortality（OR=1.07,95%CI:0.50~2.31, P=0.85）. Conclusions:For treating the unstableintertrochanteric fractures in elderly patients, hip arthroplasty is in a higher risk of intraoperative and lower risk of postoperative, but it will more likely achieve earlyfunctional exercise and higher patient satisfaction. Considering the efficacy and safety, hiparthroplasty has more advantages than DHS.