Clinical Orthopaedics and Related Research®

, Volume 470, Issue 8, pp 2235–2243 | Cite as

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

Survey

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.

Supplementary material

11999_2012_2293_MOESM1_ESM.doc (46 kb)
Supplementary material 1 (DOC 46 kb)
11999_2012_2293_MOESM2_ESM.doc (26 kb)
Supplementary material 2 (DOC 25 kb)

References

  1. 1.
    Ahn J, Man LX, Park S, Sodl JF, Esterhai JL. Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res. 2008;466:2513–2518.PubMedCrossRefGoogle Scholar
  2. 2.
    Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br. 2011;93:1045–1048.PubMedCrossRefGoogle Scholar
  3. 3.
    Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a randomized, controlled trial. J Bone Joint Surg Am. 2006;88:2583–2589.PubMedCrossRefGoogle Scholar
  4. 4.
    Bernstein J, Ahn J. In brief: fractures in brief: femoral neck fractures. Clin Orthop Relat Res. 2010;468:1713–1715.PubMedCrossRefGoogle Scholar
  5. 5.
    Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89:160–165.PubMedCrossRefGoogle Scholar
  6. 6.
    Butler M, Forte M, Kane RL, Joglekar S, Duval SJ, Swiontkowski M, Wilt T. Treatment of common hip fractures. Evid Rep Technol Assess (Full Rep). 2009;184:1–85, v.Google Scholar
  7. 7.
    Cipriani A, Barbui C. What is an individual patient data meta-analysis? Epidemiol Psichiatr Soc. 2007;16:203–204.PubMedGoogle Scholar
  8. 8.
    Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10:101–129.CrossRefGoogle Scholar
  9. 9.
    Deng R, Zhu J, Hong L, Cui H, Huang Z. [Total hip replacement and femoral head replacement in the treatment of femoral neck fractures in elderly patients] [in Chinese]. Chinese Journal of Postgraduates of Medicine. 2009;32(suppl):81–83.Google Scholar
  10. 10.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188.PubMedCrossRefGoogle Scholar
  11. 11.
    Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty. 1986;1:21–28.PubMedCrossRefGoogle Scholar
  12. 12.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.PubMedCrossRefGoogle Scholar
  13. 13.
    Enocson A, Hedbeck CJ, Törnkvist H, Tidermark J, Lapidus LJ. Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop. 2011 July 26. [Epub ahead of print].Google Scholar
  14. 14.
    Giannoudis PV, Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Management, complications and clinical results of femoral head fractures. Injury. 2009;40:1245–1251.PubMedCrossRefGoogle Scholar
  15. 15.
    Goh SK, Samuel M, Su DH, Chan ES, Yeo SJ. Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture. J Arthroplasty. 2009;24:400–406.PubMedCrossRefGoogle Scholar
  16. 16.
    Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, Tidermark J. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am. 2011;93:445–450.PubMedCrossRefGoogle Scholar
  17. 17.
    Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.PubMedCrossRefGoogle Scholar
  18. 18.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.PubMedCrossRefGoogle Scholar
  19. 19.
    Holt G, Hook S, Hubble M. Revision total hip arthroplasty: the femoral side using cemented implants. Int Orthop. 2011;35:267–273.PubMedCrossRefGoogle Scholar
  20. 20.
    Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ. 2010;340:c2332.PubMedCrossRefGoogle Scholar
  21. 21.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technol Assess. 2005;9:iii–iv, ix–x, 1–65.Google Scholar
  23. 23.
    Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty: treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88:249–260.PubMedCrossRefGoogle Scholar
  24. 24.
    Lai M. [Hemiarthroplasty and total hip arthroplasty in the treatment of femoral neck fractures in elderly patients] [in Chinese]. Chinese Journal of New Clinical Medicine. 2010;3:41–44.Google Scholar
  25. 25.
    Li L, Nie Z, Niu J. [Total hip arthroplasty and hemiarthroplasty for treatment of femoral neck fractures in elderly patients] [in Chinese]. China Foreign Medical Treatment. 2011;19:52–55.Google Scholar
  26. 26.
    Lowe JA, Crist BD, Bhandari M, Ferguson TA. Optimal treatment of femoral neck fractures according to patient’s physiologic age: an evidence-based review. Orthop Clin North Am. 2010;41:157–166.PubMedCrossRefGoogle Scholar
  27. 27.
    Macaulay W, Nellans KW, Garvin KL, Iorio R, Healy WL, Rosenwasser MP; other members of the DFACTO Consortium. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award. J Arthroplasty. 2008;23(6 suppl 1):2–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Macaulay W, Nellans KW, Iorio R, Garvin KL, Healy WL, Rosenwasser MP; DFACTO Consortium. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture. HSS J. 2008;4:48–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Macaulay W, Pagnotto MR, Iorio R, Mont MA, Saleh KJ. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg. 2006;14:287–293.PubMedGoogle Scholar
  30. 30.
    Macaulay W, Yoon RS, Parsley B, Nellans KW, Teeny SM; DFACTO Consortium. Displaced femoral neck fractures: is there a standard of care? Orthopedics. 2007;30:748–749.PubMedGoogle Scholar
  31. 31.
    Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748.PubMedGoogle Scholar
  32. 32.
    Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg. 2008;16:596–607.PubMedGoogle Scholar
  33. 33.
    Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G, Batanis G, Tsembeli A, Tzurbakis M, Safioleas M. The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. Int Orthop. 2008;32:367–373.PubMedCrossRefGoogle Scholar
  34. 34.
    Pang H. [Total hip arthroplasty and bipolar hemiarthroplasty for treatment of femoral neck fractures] [in Chinese]. China Prac Med. 2011;6:81–83.Google Scholar
  35. 35.
    Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;6:CD001706.Google Scholar
  36. 36.
    Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur: 13 year results of a prospective randomised study. Injury. 2000;31:793–797.PubMedCrossRefGoogle Scholar
  37. 37.
    Rodríguez-Merchán EC. Displaced intracapsular hip fractures: hemiarthroplasty or total arthroplasty? Clin Orthop Relat Res. 2002;399:72–77.PubMedCrossRefGoogle Scholar
  38. 38.
    Schmidt AH, Leighton R, Parvizi J, Sems A, Berry DJ. Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 2009;23:428–433.PubMedCrossRefGoogle Scholar
  39. 39.
    Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B. Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. Injury. 1989;20:291–293.PubMedCrossRefGoogle Scholar
  40. 40.
    Sterling RS. Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function. Clin Orthop Relat Res. 2011;469:1913–1918.PubMedCrossRefGoogle Scholar
  41. 41.
    van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers EL. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br. 2010;92:1422–1428.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.Department of OrthopedicsChinese General Hospital of People’s Liberation ArmyBejingChina

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