Locked plate versus retrograde intramedullary nail for periprosthetic femur fractures above total knee arthroplasty: a meta-analysis

Abstract

Locked plate (LP) and retrograde intramedullary nail (RIN) are the most commonly used treatment options for periprosthetic femur fracture above total knee arthroplasty (TKA). Controversy still exists regarding which is better. Therefore we performed a meta-analysis to compare their clinical results. A comprehensive search was conducted through PubMed, EMBase and the Cochrane Collaboration Library. Six comparative studies (265 patients) were included for the meta-analysis. No statistically significant differences were found between the LP group and RIN group in terms of six month union rate (OR, 1.19; 95% CI, 0.52-2.69; P = 0.68), union time (WMD, 0.22; 95% CI, -0.41 to 0.84; P = 0.50), operation time (WMD, 0.54; 95% CI, -13.09 to 14.17; P = 0.94) or complication rate (OR, 0.79; 95% CI, 0.22-2.91; P = 0.73). The LP fixation may have a relatively higher re-operation rate (OR, 5.17; 95% CI, 1.02-26.27; P = 0.05) compared with RIN. The mean union time was 4.0months in the LP group and 3.7months in the RIN group. This meta-analysis found no statistically significant difference in six month union rate, union time, operation time and complication rate between the LP group and RIN group. The RIN fixation may have a potential of lower re-operation rate compared with LP. The mean union time was 4.0months in the LP group and 3.7months in the RIN group.