Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly

Abstract

Background:There is conflicting evidence as to whether the femoral head should be preserved or replaced in elderly patients with displaced intracapsular femoral neck fractures. In this article, we performed a systematic review and meta-analysis to compare the short- and long-term effectiveness of arthroplasty (AR) and internal fixation (IF).Methods:PubMed, Embase, and the Cochrane Library were searched systematically up to January 2016. All randomized controlled trials directly comparing the effectiveness of AR and IF for displaced intracapsular fracture were retrieved with no limitation on language or publication year.Results:In total, eight prospective randomized studies involving 2206 patients were included. The results of our study showed that patients in the AR group reported significantly lower complication (risk ratio: 0.56, 95% confidence interval [CI] = 0.38–0.80), re-operation (risk ratio: 0.17, 95% CI = 0.13–0.22), revision rates (risk ratio: 0.11, 95% CI: 0.08–0.16), and better function compared with their IF counterparts, and they were less likely to suffer postoperative pain. No statistically significant differences for the rates of mortality, infection, and/or deep vein thrombosis between AR and IF were found.Conclusions:Based on our analysis, we recommend that AR should be used as the primary treatment for displaced intracapsular femoral neck fractures in the elderly. However, IF may be appropriate for those who are very frail.

The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

“…However, some studies believe that HA will increase the operation time and bleeding volume, bring about a higher infection rate and mortality caused by cardiovascular accidents during perioperative period [ 27 ] . Jiang et al believed that although HA does not cause a higher chance of perioperative infection, it does not improve the hip function of patients either [ 29 , 31 ]. Thus, in this study, it is necessary to conduct research on the abovementioned issues in those two treatments based on most recent literature.…”

“…We speculated that patients can exercise as early as possible after hemiarthroplasty to achieve functional recovery, and the bed rest time after internal fixation is relatively longer, resulting in untimely exercise and limited functional recovery. However, the functional weakness of the IF group became less obvious during long-term follow-up [ 29 , 31 ], which may be due to that better exercise achieved a more satisfactory functional recovery in the later period of the IF group. The literature on the EQ-5D score in this study is relatively rare, especially that there are only 3 studies in the 2-year group, and the results are mainly based on the subjective score of the patient, without no further accurate functional evaluation.…”

Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis

“…Several meta-analysis studies report that replacement AP is a more suitable surgical option in patients with femur neck fracture (789). Although few studies report the more suitable option for early rehabilitation in patients with unstable intertrochanteric fracture, replacement AP vs.…”

Optimal design and biomechanical simulation analysis of femoral stem based on trabecular bone structure

“…Results showed that the load conduction effect of the trabecular stem was better when implanted into human body and the stress distribution was more uniform. Previous studies have shown that the femoral stem is the weakest part of the hip prosthesis component under the in uence of stress concentration [21][22][23][24] . Therefore, optimizing the middle part of the stem with porous structure is reasonable for reducing stress concentration and improving life service.…”