Background Trochanteric fracture (TF) is of high incidence, especially among geriatric patients with osteoporosis. It imposes a heavy burden on both society and individuals. Surgical operation is the preferred choice for the treatment of TF, and intramedullary fixation and arthroplasty are two mainstream surgical procedures performed in clinical settings. This meta-analysis aims to attempt to explore the superiority of intramedullary fixation and arthroplasty in treating geriatric TF concerning the functional recovery, complications, mortality, and other operative details. Methods This review was planned, conducted, and reported following the PRISMA 2020 guidelines. By searching online databases (PubMed, Cochrane Library, Web of Science), related prospective studies from the year of 2000 to April 2024 were included in this meta-analysis. The language was restricted to English and Chinese. Studies were screened by two researchers independently, and the results of interest were analyzed by RevMan (version 5.4) and R (version 4.5.3). Both the conventional DerSimonian-Laird (DL) method and the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment were employed to compare results, enhancing methodological transparency, and ensuring a more objective interpretation of therapeutic differences. Results A total of 981 studies were screened, of which 12 studies (7 randomized controlled trials (RCTs) and 5 prospective non-randomized controlled trials (non-RCTs)) involving 1,262 patients were finally included. Intramedullary fixation was associated with significantly shorter operative time (WMD -21.47, 95% CI -36.84 to -6.11, P = 0.006), reduced operative blood loss (WMD -176.29, 95% CI -232.32 to -120.27, P < 0.001), and superior long-term functional recovery at 12 months (SMD 0.50, 95% CI 0.16 to 0.84, P = 0.004). Notably, while initial DL estimates suggested that arthroplasty had advantages in short-term functional recovery (within 6 months, P = 0.04) and lower implant-related complications (P = 0.003), these differences lost statistical significance following the more conservative HKSJ adjustment (P = 0.1069 and P = 0.0565, respectively). However, arthroplasty maintained a lower revision rate (P = 0.009) across both models. Subgroup analyses indicated that nail types and fracture stability did not fundamentally alter the comparative trends (Pinteraction > 0.05), except for blood loss (Pinteraction = 0.0116). Meta-regression revealed that publication year significantly contributed to the heterogeneity of blood loss (P = 0.0133, R2 = 51.51%), while mean age did not significantly influence any observed endpoints (all P > 0.05). No significant differences were observed in mortality, full weight-bearing time, general complications, or hospitalization time (P > 0.05). Conclusions Intramedullary fixation remains the primary choice for geriatric trochanteric fractures due to shorter operative times, reduced blood loss, and superior long-term function. Arthroplasty may offer potential advantages in short-term recovery, lower revision rates, and fewer implant-related complications, though these benefits were sensitive to the statistical model used. Therefore, primary arthroplasty should be considered a strategic alternative rather than a routine replacement, particularly for patients with poor bone quality or pre-existing hip arthritis.

Intramedullary fixation versus arthroplasty in the treatment of geriatric trochanteric fractures: a systematic review and meta-analysis

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2026年7月6日

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Zheng Liu,
Frankie Ka Li Leung,
Shuzhuang Peng

摘要

Background

Trochanteric fracture (TF) is of high incidence, especially among geriatric patients with osteoporosis. It imposes a heavy burden on both society and individuals. Surgical operation is the preferred choice for the treatment of TF, and intramedullary fixation and arthroplasty are two mainstream surgical procedures performed in clinical settings. This meta-analysis aims to attempt to explore the superiority of intramedullary fixation and arthroplasty in treating geriatric TF concerning the functional recovery, complications, mortality, and other operative details.

Methods

This review was planned, conducted, and reported following the PRISMA 2020 guidelines. By searching online databases (PubMed, Cochrane Library, Web of Science), related prospective studies from the year of 2000 to April 2024 were included in this meta-analysis. The language was restricted to English and Chinese. Studies were screened by two researchers independently, and the results of interest were analyzed by RevMan (version 5.4) and R (version 4.5.3). Both the conventional DerSimonian-Laird (DL) method and the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment were employed to compare results, enhancing methodological transparency, and ensuring a more objective interpretation of therapeutic differences.

Results

A total of 981 studies were screened, of which 12 studies (7 randomized controlled trials (RCTs) and 5 prospective non-randomized controlled trials (non-RCTs)) involving 1,262 patients were finally included. Intramedullary fixation was associated with significantly shorter operative time (WMD -21.47, 95% CI -36.84 to -6.11, P = 0.006), reduced operative blood loss (WMD -176.29, 95% CI -232.32 to -120.27, P < 0.001), and superior long-term functional recovery at 12 months (SMD 0.50, 95% CI 0.16 to 0.84, P = 0.004). Notably, while initial DL estimates suggested that arthroplasty had advantages in short-term functional recovery (within 6 months, P = 0.04) and lower implant-related complications (P = 0.003), these differences lost statistical significance following the more conservative HKSJ adjustment (P = 0.1069 and P = 0.0565, respectively). However, arthroplasty maintained a lower revision rate (P = 0.009) across both models. Subgroup analyses indicated that nail types and fracture stability did not fundamentally alter the comparative trends (P_interaction > 0.05), except for blood loss (P_interaction = 0.0116). Meta-regression revealed that publication year significantly contributed to the heterogeneity of blood loss (P = 0.0133, R² = 51.51%), while mean age did not significantly influence any observed endpoints (all P > 0.05). No significant differences were observed in mortality, full weight-bearing time, general complications, or hospitalization time (P > 0.05).

Conclusions

Intramedullary fixation remains the primary choice for geriatric trochanteric fractures due to shorter operative times, reduced blood loss, and superior long-term function. Arthroplasty may offer potential advantages in short-term recovery, lower revision rates, and fewer implant-related complications, though these benefits were sensitive to the statistical model used. Therefore, primary arthroplasty should be considered a strategic alternative rather than a routine replacement, particularly for patients with poor bone quality or pre-existing hip arthritis.