A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures

Liang Liao, Jin min Zhao, Wei Su, Xiao fei Ding, Liang jun Chen, Shi xing Luo
Archives of Orthopaedic and Trauma Surgery 2012, 132 (7): 1021-9

BACKGROUND: Total hip arthroplasty or hemiarthroplasty are used to treat displaced femoral neck fractures. However, the optimal treatment of these fractures remained controversial.

OBJECTIVE: To assess the effects that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fractures in the elderly.

METHODS: We searched MEDLINE (January 1980 to 2010), EMBASE (January 1980 to 2010), and the Cochrane Library 2010; issue 1. Only prospective randomized controlled trials (RCTs) that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fracture in the elderly were included. The analysis was performed with software RevMan5.0 from the Cochrane Collaboration.

RESULTS: We identified seven relevant randomized controlled trials with a total of 828 participants. The meta-analysis showed relative risk of re-operation was 0.40 (95% CI = 0.24-0.67, P = 0.0004), the dislocation was 2.02 (95% CI = 1.26-3.25, P = 0.002), the mobility as functional outcome was 1.70 (95% CI = 1.21-2.38, P = 0.002). It was reported that the average operating room times and blood loss volumes in total hip arthroplasty were more than in hemiarthroplasty (P < 0.001). Other results were not significantly different.

CONCLUSIONS: Total hip arthroplasty is associated with better functional outcome and lower reoperation rate than hemiarthroplasty in treatment of displaced femoral neck fractures in the elderly patients.

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