Outcome of hemiarthroplasty and total hip replacement for active elderly patients with displaced femoral neck fractures: a meta-analysis of 8 randomized clinical trials.
BACKGROUND
Displaced 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.


METHODS
A 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.


RESULTS
A 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).


CONCLUSIONS
Even 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.
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Yiqiong
Y
Zhao
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Dong
D
Fu
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Kai
K
Chen
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Guodong
G
Li
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Zhengdong
Z
Cai
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Yan
Y
Shi
The Tenth People's Hospital Affiliated with Tong Ji University Shanghai, China.
Xiaobing
X
Yin
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005265:Femoral Neck Fractures / Q000601:surgery*; D062785:Hemiarthroplasty; D006801:Humans; D016032:Randomized Controlled Trials as Topic