Proximal femoral nail anti-rotation versus hip arthroplasty for osteoporotic intertrochanteric fracture: surgical effects and indications

Objective: To compare the differences between proximal femoral nail anti-rotation (PFNA) and hip arthroplasty (HA) in treatment of osteoporotic intertrochanteric fracture and explore indications for selection between the two systems. Methods: One hundred patients with osteoporotic intertrochanteric fracture admitted to Ningbo NO.2 Hospital between January 2015 and December 2017 were enrolled for the study and randomized into the PFNA group and the HA group (n=50 in each group). Patients in the PFNA group were applied proximal femoral intramedullary nail fixation, whereas those in the HA group received HA. Duration of surgery, intraoperative blood loss, duration of hospital stay, effectiveness, and post-surgery complications were compared. Harris hip score was utilized at one year after the surgery to assess the recovery of the patients' hip joints. Results: PFNA group had shorter duration of surgery, and significantly less intraoperative blood loss than the HA group (both P<0.05). No significant difference existed in the duration of hospital stay (P=0.357). The effectiveness rate was 88% with PFNA and 94% with HA, without statistical significance (P=0.485). The incidences of post-surgery deep venous thrombosis, pulmonary infection, and joint dislocation in the PFNA group were significantly lower than those in the HA group (all P<0.05). No statistical difference was observed in prosthetic loosening between the two groups (P=0.674). The one year post-surgery Harris hip score showed significantly a higher score in the PFNA group than in the HA group (P<0.05). Conclusion: PFNA is a rational choice for patients with osteoporotic intertrochanteric fracture for its advantages as shorter duration of surgery, less intraoperative blood loss, lower incidence of post-surgery complications, and excellent function recovery of the hip joints.