Outcomes of dual-mobility total hip arthroplasty versus bipolar hemiarthroplasty for patients with femoral neck fractures: a systematic review and meta-analysis

Hsiao, Hsuan; Chou, Te Feng Arthur; Pai, Fu Yuan; Tsai, Shi-Chun; Chen, Cheng Fong; Wu, Po Kuei; Chen, Wei Ming

doi:10.1186/s13018-021-02316-6

Cited by 10 publications

(11 citation statements)

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“…HHA is the preferred treatment option for displaced FNF, as it is faster and leads to satisfactory function and performance in the elderly [20][21][22][23]. In HHA, surgeons can choose to use a unipolar or bipolar femoral head, using the latter to maximize the longevity of the implant.…”

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis

Migliorini

Maffulli

Trivellas

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Displaced femoral neck fractures (FNF) usually require surgical treatment with either a total hip arthroplasty (THA), unipolar hemiarthroplasty (U-HHA), or bipolar hemiarthroplasty (B-HHA). However, there is still controversy regarding the optimal implant. This network meta-analysis compared the outcomes and complication rates of THA versus B-HHA and versus U-HHA in elderly patients with FNF. Material and methods This study was conducted according to the PRISMA extension statement for reporting of systematic reviews, and incorporated network meta-analyses of health care interventions. The literature search was performed in September 2020. All randomized clinical trials comparing two or more of the index surgical interventions for displaced FNF in the elderly were eligible for inclusion. For the Bayesian network meta-analysis, the standardized mean difference (SMD) and Log Odd Ratio (LOR) were used. Results Data from 24 RCTs (2808 procedures) were analysed. The mean follow-up was 33.8 months. The THA group had the longest surgical time (SMD 85.74) and the greatest Harris Hip Score (SMD − 17.31). THA scored similarly in terms of mortality (LOR 3.89), but had lower rates of revision surgeries (LOR 2.24), higher rates of dislocations (LOR 2.60), and lower rates of acetabular erosion (LOR − 0.02). Cementless implants required a shorter surgical duration (− 18.05 min; P = 0.03). Mortality was positively associated with acetabular erosion (P = 0.006), female gender (P = 0.007), revision (P < 0.0001). Conclusion THA led to the highest Harris Hip scores and lowest rate of revision surgery compared to B-HHA and U-HHA. However, B-HHA had the lowest dislocation rate when compared with U-HHA and THA. No significant differences in functional outcomes and complication rates were found between cemented and uncemented implants; however, a tendency for lower mortality, revision and dislocation rates in cemented implants was evidenced. Level of evidence I, Bayesian network meta-analysis of RCTs.

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Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis

Migliorini

Maffulli

Trivellas

et al. 2022

Eur J Trauma Emerg Surg

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“…Many meta-analyses consider THA to be superior to HA in patients with femoral neck fractures [ 11 – 13 ]. On the other hand, many other meta-analyses find no relevant overall difference in outcome between HA and THA in patients with femoral neck fractures [ 10 , 14 , 65 – 67 ].…”

Section: Discussionmentioning

confidence: 99%

Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients

Ramadanov,

Jóźwiak,

Hauptmann

et al. 2023

J Orthop Surg Res

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Background Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications. Methods We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. Results A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = − 57.70, 95% CI − 72.78; − 42.62; DHS: MD = − 53.56, 95% CI − 76.17; − 30.95; HA: MD = − 20.90, 95% CI − 30.65; − 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = − 3.67, 95% CI − 4.44; − 2.90; DHS: MD = − 3.20, 95% CI − 4.97; − 1.43; HA: MD = − 1.20, 95% CI − 1.73; − 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2 years postoperatively: CS: MD = − 0.20, 95% CI − 0.29; − 0.11; HA: MD = − 0.09, 95% CI − 0.17; − 0.02; THA: MD = 1.00 reference; HHS 2 years postoperatively: CS: MD = − 5.50, 95% CI − 9.98; − 1.03; DHS: MD = − 8.93, 95% CI − 15.08; − 2.78; HA: MD = − 3.65, 95% CI − 6.74; − 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference). Conclusion In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases. Level of evidence I: a systematic review of randomized controlled trials. Trial registration: PROSPERO on 10 August 2022 (CRD42022350293).

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“…Male patients are more likely to have an acetabular component size that accommodates a large femoral head, and this may explain the slightly higher percentage of THAs performed in men, given our inclusion criteria. Systematic reviews have concluded that DM bearings are equivalent, or superior, to large femoral bearings in reducing the risk of dislocation in primary and revision surgery [61][62][63][64] and have a lower risk of dislocation and revision than HA 65 . Systematic reviews have supported the use of DM bearings as a viable option for FNF 66 .…”

Section: Discussionmentioning

confidence: 99%

Is the Revision Rate for Femoral Neck Fracture Lower for Total Hip Arthroplasty Than for Hemiarthroplasty?

Hoskins

Corfield

Lorimer

et al. 2022

Journal of Bone and Joint Surgery

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Background:When arthroplasty is indicated for a femoral neck fracture (FNF), it is unclear whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is best. This study compares data from the Australian Orthopaedic Association National Joint Replacement Registry using contemporary surgical options.Methods:Patients from 60 to 85 years old who were treated with arthroplasty for FNF, between September 1999 and December 2019, were included if the femoral stems were cemented. Only THAs with femoral heads of ≥36 mm or dual-mobility articulations were included. Patients who had monoblock HA were excluded. Rates of revision for all aseptic failures and dislocation were compared. Competing risks of revision and death were considered using the cumulative incidence function. Subdistribution hazard ratios (HRs) for revision or death from a Fine-Gray regression model were used to compare THA and HA. Interactions of procedure with age group and sex were considered. Secondary analysis adjusting for body mass index (BMI) and American Society of Anesthesiologists (ASA) classification was also considered.Results:There were 4,551 THA and 29,714 HA procedures included. The rate of revision for THA was lower for women from 60 to 69 years old (HR = 0.58 [95% confidence interval (CI), 0.39 to 0.85]) and from 70 to 74 years old (HR = 0.65 [95% CI, 0.43 to 0.98]) compared with HA. However, women from 80 to 85 years old (HR = 1.56 [95% CI, 1.03 to 2.35]) and men from 75 to 79 years old (HR = 1.61 [95% CI, 1.05 to 2.46]) and 80 to 85 years old (HR = 2.73 [95% CI, 1.89 to 3.95]) had an increased rate of revision when THA was undertaken compared with HA. There was no difference in the rate of revision for dislocation between THA and HA for either sex or age categories.Conclusions:When contemporary surgical options for FNF are used, there is a benefit with respect to revision outcomes for THA in women who are <75 years old and a benefit for HA in women who are ≥80 years old and men who are ≥75 years old. There is no difference in dislocation rates.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Outcomes of dual-mobility total hip arthroplasty versus bipolar hemiarthroplasty for patients with femoral neck fractures: a systematic review and meta-analysis

Cited by 10 publications

References 28 publications

Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis

Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis

Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients

Is the Revision Rate for Femoral Neck Fracture Lower for Total Hip Arthroplasty Than for Hemiarthroplasty?

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