title: Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The optimal management of intracapsular fractures of the femoral neck in independently mobile patients remains open to debate. Successful fixation obviates the limitations of arthroplasty for this group of patients. However, with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip arthroplasty (THA) must be considered. We carried out a systematic review to compare the outcomes of salvage THA and primary THA for intracapsular fractures of the femoral neck.
  
  
  METHODS
  We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) compliant systematic review, using the PubMed, EMBASE and Cochrane libraries databases. A meta-analysis was performed where possible, and a narrative synthesis when a meta-analysis was not possible.
  
  
  RESULTS
  Our analyses revealed a significantly increased risk of complications including deep infection, early dislocation and peri-prosthetic fracture with salvage THA when compared with primary THA for an intracapsular fracture of the femoral neck (overall risk ratio of 3.15). Functional outcomes assessment using EuroQoL (EQ)-5D were not significantly different (p = 0.3).
  
  
  CONCLUSIONS
  Salvage THA carries a significantly higher risk of complications than primary THA for intracapsular fractured neck of femur. Current literature is still lacking well designed studies to provide a full answer to the question.
  
  
  CONCLUSIONS
  Salvage THA is associated with more complications than primary THA for intracapsular neck of femur fractures.
authors.affiliation: Health Education North East South Tees NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK.
authors.forename: S S S
authors.initials: SS
authors.lastname: Mahmoud
authors.affiliation: St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, SW17 0QT, London, UK.
authors.forename: E O
authors.initials: EO
authors.lastname: Pearse
authors.affiliation: University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
authors.forename: T O
authors.initials: TO
authors.lastname: Smith
authors.affiliation: St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, SW17 0QT, London, UK.
authors.forename: C B
authors.initials: CB
authors.lastname: Hing
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D012086:Reoperation; D016879:Salvage Therapy / Q000379:methods*; D017211:Treatment Failure
keywords: Arthroplasty; Femur; Fixation; Fracture; Hip; Intra-capsular; Neck; outcomes