Functional outcome and revision rate of proximal femoral nail antirotation versus dynamic hip screw for osteoporotic intertrochanteric femur fracture: A systematic review and meta-analysis

Abstract

Introduction: Intertrochanteric femur fracture in elderly presents a challenge as the source of morbidity if not well-treated. This study investigates the functional outcome and revision rate of two of the most common treatments of choice for this condition, proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS), while furthermore investigate the secondary functional outcome of the two procedures if proceeded to conversion to total hip arthroplasty (CTHA). Methods: A systematic search was conducted based on PRISMA guideline to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 9 studies (2.251 patients) were included, divided into three meta-analysis, processed using Review Manager 5.3. Results: For primary Harris Hip Score (HHS), 3 articles were included, with a total sample of 371 patients (184 PFNA vs. 187 DHS). For primary HHS, the mean HHS at 12-month follow-up for PFNA (n = 184) was 77.77, as for DHS (n = 187) was 78.33, indicating no significant difference (P = 0.73). For the revision rate, 4 articles were included, with a total of 1550 samples (784 PFNA vs. 766 DHS). The mean revision rates for PFNA (n = 784) was 2.68%, as for DHS (n = 766) was 2.48%, indicating no significant difference (P = 0.61). For secondary HHS after CTHA, two articles were included, with a total amount of 332 patients (142 PFNA vs. 190 DHS). In terms of secondary HHS after CTHA, the mean HHS 12-month postoperatively for PFNA (n = 142) was 83.97, as for DHS (n = 190) was 83.65, indicating no significant difference (P = 0.59). Conclusion: The current systematic review and meta-analysis suggest that PFNA and DHS both have comparable primary functional outcome, revision rate, and post-CTHA secondary functional outcome.