Comparison of proximal femoral nail antirotation internal fixation and artificial hip replacement for elderly patients with intertrochanteric fractures.

Abstract

Objective: To compare the effects of proximal femoral nail antirotation (PFNA) internal fixation and artificial hip replacement (AHR) on serum inflammatory factors and hip function recovery in elderly patients with intertrochanteric fractures (IFs).

Methods: One hundred and thirty patients with IFs who underwent surgery at the People's Hospital of Pingyang between July 2018 and July 2020 were enrolled. Sixty-five patients received PFNA internal fixation (fixation group) and 65 received AHR (replacement group). Surgical indicators and complications were recorded in both groups. The Harris Hip Scale was used to score hip joint function, the Visual Analog Scale (VAS) to assess pain, the MOS 36-Item Short-Form Health Survey (SF-36) to evaluate life quality, and enzyme-linked immunosorbent assay to measure serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β.

Results: The replacement group experienced notably shorter hospitalization times, less complete weight-bearing time, and earlier time to walk compared to the fixation group (all P<0.05). The replacement group also showed a lower incidence of poor fracture healing and complications (both P<0.05). Additionally, on postoperative days 3, 15, and 45, the replacement group had notably lower VAS scores (all P<0.05). Furthermore, the replacement group exhibited higher Harris Hip Scale scores at 1, 2, and 3 months post-surgery (all P<0.05). Higher postoperative SF-36 scores were also observed in the replacement group (P<0.05). On postoperative day 30, both groups presented decreases in TNF-α, IL-6, and IL-1β levels compared to preoperative levels, with even lower levels in the replacement group (all P<0.05).

Conclusions: AHR can help elderly patients with IFs ambulate earlier, speed up hip function recovery, reduce inflammation, and improve life quality with fewer postoperative complications, making it worthy of clinical promotion.