Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review

Abstract

Objective To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Design Systematic review and meta-analysis of randomised trials, quasirandomised trials, and cohort studies. Data sources Medline, Embase, Cochrane register of controlled trials, publishers' databases, and manual search of bibliographies. Study selection Randomised controlled trials, quasirandomised trials, and cohort studies (retrospective and prospective) comparing hemiarthroplasty with total hip arthroplasty for treating displaced femoral neck fractures in patients aged more than 60 years. Data extraction Relative risks, risk differences, and mean differences from each trial, aggregated using random effects models. Analyses were stratified for experimental and non-experimental designs, and two way sensitivity analyses and tests for interaction were done to assess the influence of various criteria of methodological quality on pooled estimates. Data synthesis 3821 references were identified. Of the 202 full papers inspected, 15 were included (four randomised controlled trials, three quasirandomised trials, and eight retrospective cohort studies, totalling 1890 patients). Meta-analysis of 14 studies showed a lower risk of reoperation after total hip arthroplasty compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%), although this effect was mainly driven by investigations without concealed treatment allocation. Total hip arthroplasty consistently showed better ratings in the Harris hip score (three studies, 246 patients, weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods of 12 to 48 months. The standardised mean difference of different scores from five studies was 0.42 (95% confidence interval 0.24 to 0.

High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

“…This study raises one of the major issues related to the risk of dislocation in femoral neck fractures. A systematic review [11] showed that single-stage THA may lead to lower reoperation rates and better functional outcomes compared with hemiarthroplasty in patients with displaced femoral neck fractures. If the increased risk of dislocation is confirmed as compared with hemiarthroplasty, surgeons might consider THA if the risk of dislocation can be reduced either by modifying the surgical approach or considering alternative cup designs such as constrained liners and the dual-mobility cup.…”

Anterior screw fixation of type IIB odontoid fractures in octogenarians

“…Thus, surgery in the octogenarian must take into account a number of factors, such as lack of synchronism between physiological age and chronological age, quality of life, risk/benefit ratio and increase in health care costs, an element that is gaining more and more importance [7,19,23,25]. The issue has been settled for other surgical pathologies such as hip fractures [10] or cardiac valve replacement [12]. Secondly, more and more people aged over 80, at greater risk of ground-level falls, have upper cervical spine injuries [19].…”

Dislocation Rate Fallowing Posterior Total Hip Arthroplasty with Intra-Osseous Soft Tissue Repair

“…The Muscles & soft tissues damage as indicated with serum CK is 5.5 more in posterior than minimally invasive anterior total hip arthroplasty approach [1]. The anterior approach had the early hospital discharge, good rehabilitation, & fewer readmission rates [10,11]. Where subjects operated with the posterior approach reported significantly higher stiffness than anterior subjects, but similar pain and function [12].…”