title: Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis.
abstract: BACKGROUND
  Displaced femoral neck fractures (FNFs) in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA) or total hip arthroplasty (THA), with studies suggesting that THA may be the better option. However, it has recently been reported that bipolar HA (BHA) also provides good outcomes, and it is not clear as to whether BHA or THA is most appropriate. The purpose of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of BHA with THA for treating FNF in healthy elderly patients.
  
  
  METHODS
  We searched the following databases from inception to May 2015 for relevant RCTs without language restrictions: PubMed, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE and EMBASE, CINAHL, the China Biological Medicine Database, International Clinical Trials Registry Platform, Current Controlled Trials, and ClinicalTrials.gov. RCTs that met the inclusion criteria were statistically analyzed using the Cochrane review methods.
  
  
  RESULTS
  Eight RCTs were included (total 1,014 patients; 523 had BHA and 491 had THA). The data from included RCTs were divided into four subgroups according to different follow-up durations. The Harris Hip Score after BHA was not different from that after THA in all subgroups. Both reoperation rate and acetabular erosion rate were higher after BHA after more than 4 years, while there was a higher dislocation rate associated with THA within 4 years. THA was more favorable regarding the EQindex-5D and the mobility and pain rate, while BHA was more favorable regarding operating time. No significant differences were found regarding infection rate, general complications, 1-year mortality, blood loss, and length of postoperative hospital stay.
  
  
  CONCLUSIONS
  For healthy elderly patients with displaced FNFs, treatment with BHA led to better outcomes regarding dislocation rate, while THA was better regarding acetabular erosion rate and reoperation rate. When comparing BHA with THA, there were no significant differences in other important outcomes such as Harris Hip Score, infection rate, general complications, and 1-year mortality. Further high-quality RCTs are needed to provide robust evidence and evaluate the treatment options.
authors: Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China. wangfengdr_cmu@163.com.
authors: Feng
authors: F
authors: Wang
authors: Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China. actor_1999@126.com.
authors: Haifei
authors: H
authors: Zhang
authors: Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China. zhangzhiyudr_cmu4h@163.com.
authors: Zhiyu
authors: Z
authors: Zhang
authors: Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China. 18900912433@163.com.
authors: Chengbin
authors: C
authors: Ma
authors: Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China. Fxm1972@126.com.
authors: Ximin
authors: X
authors: Feng
mesh_terms: D000077:Acetabulum / Q000473:pathology; D000368:Aged; D001170:Arthritis, Infectious / Q000453:epidemiology; D001178:Arthroplasty / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005265:Femoral Neck Fractures / Q000473:pathology / Q000601:surgery*; D006617:Hip Dislocation / Q000453:epidemiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome