Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fractures: Meta-analysis of Randomized Trials

Abstract

Background Most patients with displaced femoral neck fractures are treated by THA and hemiarthroplasty, but it remains uncertain which if either is associated with better function and lower risks of complications. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to determine whether THA was associated with lower rates of reoperations, mortality, complications, and better function compared with hemiarthroplasty. Methods We searched the PubMed, Embase, Chinese Biomedicine Literature, and Cochrane Register of Controlled Trials databases and identified 12 RCTs (including a total of 1320 patients) for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) from each trial were pooled using random-effects or fixed-effects models depending on the heterogeneity of the included studies. Results THA was associated with a lower risk of subsequent reoperations compared with hemiarthroplasty (RR = 0.53; 95% CI, 0.34-0.84). There was no difference in mortality between patients undergoing THA and hemiarthroplasty (RR = 0.81; 95% CI, 0.60-1.09). For complications, there was a higher risk of dislocation in patients undergoing THA (RR = 1.99; 95% CI, 1.26-3.15), but there were no differences in local infections (RR = 1.60; 95% CI, 0.74-3.46) and general complications (RR = 1.15; 95% CI, 0.91-1.45). Patients with THA had higher Harris hip scores at 1 year (WMD = 3.81; 95% CI, 0.87-6.74) and at 3 or 4 years (WMD = 10.07; 95% CI, 6.92-13.21). Conclusions Despite more dislocations, THA can benefit patients with displaced femoral neck fractures with a lower reoperation rate and higher functional scores.

Internal fixation of fragility fracturesof the femoral neck

“…They also found indications of better functional outcome following total hip replacement compared to hemiarthroplasty ). The latter has been supported by two recent meta-analyses (Hopley et al 2010, Yu et al 2012). However, a recently published long-term follow up of a randomized controlled trial found that patients with mental impairment who received total hip replacement had a complication rate of 16% similar to the patients treated by internal fixation for a displaced femoral neck fracture (Johansson 2014).…”

Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures

“…Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality and obvious loss of independence [2,3]. It is estimated that the annual medical costs owing to hip fractures will be more than US $15 billion at this time [4].…”

The Frank Stinchfield Award

“…There is much evidence supporting THA for treatment of femoral neck fractures in active elderly patients [3,11,15,21,22]. However, we found that patients undergoing THA for femoral neck fracture were more likely to die within 30 days of surgery, experience a major postoperative medical complication, have a reoperation, stay in the hospital longer, and be discharged to a postacute care facility than were patients undergoing THA for OA.…”

“…However, more recent evidence emphasizes the functional advantages of THA over hemiarthroplasty in the treatment of femoral neck fractures in active elderly patients [3,11,15,21,22]. Additionally, in patients who develop a painful hemiarthroplasty, conversion of hemiarthroplasty to THA is more difficult and associated with more complications than a primary THA for osteoarthritis (OA) [19].…”