Comparison of clinical outcomes between PFNA internal fixation and DAA hemiarthroplasty for femoral intertrochanteric fracture in elderly patients
Zang Xiliang
Pan Yuehai
Shen Linhua
Wang Zuofeng
Cai Chengming
Wang Xiaojun
Song Tao
Jiang Zhihui
Abstract：Objective To compare clinical outcomes of proximal femoral nail anti-rotation(PFNA)internal fixation versus direct anterior approach(DAA)artificial femoral head replacement for femoral intertrochanteric fractures in elderly patients,provi-ding references for clinical treatment.Methods Clinical data of 122 elderly patients with femoral intertrochanteric fractures treated at the 970 th Hospital from January 2020 to January 2023 were retrospectively analyzed.Patients were allocated to PF-NA internal fixation group(n=71)and DAA artificial femoral head replacement group(n=51)based on surgical approach.Surgical-related indicators,hip function at different timepoints pre/postoperatively,bone mineral density(BMD)preoperative-ly and at 12 months,femoral neck-shaft angle changes and femoral shortening at postoperative timepoints,and postoperative complications were compared.Results The PFNA internal fixation group had shorter operative time,time to weight-bearing,hospital stay,and fracture healing time;smaller incision length;and less intraoperative blood loss than the DAA artificial fem-oral head replacement group,with statistical significance(P<0.05).Significant group and time effects for Harris scores and significant time effects for visual analogue scale(VAS)scores were noted(P<0.05).At 3 months postoperatively,Harris scores were higher and VAS scores lower in the PFNA internal fixation group than in the DAA artificial femoral head replace-ment group(P<0.05);no differences in Harris scores or VAS scores were observed at 6 or 12 months(P>0.05).At 12 months postoperatively,BMD at greater trochanter,femoral neck,and Ward's triangle increased significantly compared with preoperative levels in both groups,with significantly higher values in the PFNA internal fixation group than the DAA artificial femoral head replacement group(P<0.05).Significant group and time effects were found for femoral neck-shaft angle chan-ges and femoral shortening degree(P<0.05).At all timepoints,femoral neck-shaft angle changes and femoral shortening de-gree were significantly smaller in the PFNA internal fixation group than in the DAA group(P<0.05).No significant differ-ence was noted in complication rates during hospitalization(χ2=1.483,P=0.223).Conclusion Compared with DAA artifi-cial femoral head replacement,PFNA internal fixation offers advantages including shorter operative time,reduced trauma,and faster recovery for elderly patients with femoral intertrochanteric fractures,facilitating hip function recovery and maintaining joint stability.
Keywords：PFNA internal fixationDAA artificial femoral head replacementElderly femoral intertrochanteric fractureClini-cal value
Publication Date：2025-04-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 69-75 )