Outcome of Hemiarthroplasty and Total Hip Replacement for Active Elderly Patients with Displaced Femoral Neck Fractures: A Meta-Analysis of 8 Randomized Clinical Trials

Abstract

BackgroundDisplaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis.MethodsA literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted.ResultsA total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: −7.11, 95%:−10.70,−3.53) one year postoperatively and the advantage kept over (SMD: −6.91, 95%:−12.98, −0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19).ConclusionEven though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.

Hemiprosthesis for Femoral Neck Fractures in the Elderly: A Retrospective Study of 319 Patients

“…Hip function measured by the Harris hip score was significantly better in the total hip replacement group at 4 and 12 months after surgery (P = 0.011 and P < 0.001, respectively) (23). Other authors have reported similar results (24, 25). …”

Major Complications and Transfusion Rates After Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures

“…NSQIP database does not provide any detail regarding the transfusion strategy (liberals vs restrictive) although recent studies conducted on high-risk patients after hip fracture surgery have shown no difference in the rate of perioperative morbidity or death with either approach [43,44]. Finally, dislocations are not reported in NSQIP despite a higher rate after THA compared to HA for femoral neck fractures [3,6,15,24,45]. Therefore, surgeons should take into account the higher dislocation rate reported in previous studies when considering THA for the treatment of a displaced femoral neck fracture.…”

“…However, other randomized controlled trials comparing HA with THA for femoral neck fractures have reported no difference in blood loss [22,23]. In a recent meta-analysis of randomized clinical trials, Zhao et al [24] found no advantage in either group and stressed the need for further studies.The primary objective of this study was to compare the risk of 30-day major complications between HA and THA after femoral No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.…”

“…However, other randomized controlled trials comparing HA with THA for femoral neck fractures have reported no difference in blood loss [22,23]. In a recent meta-analysis of randomized clinical trials, Zhao et al [24] found no advantage in either group and stressed the need for further studies.…”

Operative Therapie medialer Oberschenkelhalsbrüche

“…4) (4). Die Entscheidung zwischen der Hemiarthroplastik und der totalen Endoprothese hängt vom präoperativen Aktivitätsniveau des Patienten ab (15,16). Patienten, die die Wohnung noch verlassen und längere Strecken gehen oder Sport treiben, profitieren von einer TEP (▶ Abb.…”