Skip to main content
SpringerLink
Log in

A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Total hip arthroplasty or hemiarthroplasty are used to treat displaced femoral neck fractures. However, the optimal treatment of these fractures remained controversial.

Objective

To assess the effects that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fractures in the elderly.

Methods

We searched MEDLINE (January 1980 to 2010), EMBASE (January 1980 to 2010), and the Cochrane Library 2010; issue 1. Only prospective randomized controlled trials (RCTs) that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fracture in the elderly were included. The analysis was performed with software RevMan5.0 from the Cochrane Collaboration.

Results

We identified seven relevant randomized controlled trials with a total of 828 participants. The meta-analysis showed relative risk of re-operation was 0.40 (95% CI = 0.24–0.67, P = 0.0004), the dislocation was 2.02 (95% CI = 1.26–3.25, P = 0.002), the mobility as functional outcome was 1.70 (95% CI = 1.21–2.38, P = 0.002). It was reported that the average operating room times and blood loss volumes in total hip arthroplasty were more than in hemiarthroplasty (P < 0.001). Other results were not significantly different.

Conclusions

Total hip arthroplasty is associated with better functional outcome and lower reoperation rate than hemiarthroplasty in treatment of displaced femoral neck fractures in the elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Aynardi M, Pulido L, Parvizi J et al (2009) Early mortality after modern total hip arthroplasty. J Clin Orthop Relat Res 467(1):213–218

    Article  Google Scholar 

  2. Baker RP, Squires B, Gargan MF et al (2006) 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 88(12):2583–2589

    Article  PubMed  CAS  Google Scholar 

  3. Bhandari M, Devereaux PJ, Tornetta P et al (2005) Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg 88A:2122–2130

    Article  Google Scholar 

  4. Bilgen OF, Karaeminogullari O, Kulekcioglu A (2000) Results of conversion total hip prosthesis performed following painful hemiarthroplasty. J Int Med Res 28:307–312

    PubMed  CAS  Google Scholar 

  5. Blomfeldt R, Törnkvist H, Eriksson K et al (2007) 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 89(2):160–165

    Article  PubMed  CAS  Google Scholar 

  6. Rogmark Cecilia, Johnell Olof (2006) Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. J Acta Orthop 77(3):359–367

    Article  Google Scholar 

  7. D’Arcy J, Devas M (1976) Treatment of fractures of the femoral neck by replacement with the Thompson prosthesis. J Bone Joint Surg Br 58:279–286

    PubMed  Google Scholar 

  8. Dorr LD, Glousman R, Hoy AL et al (1986) Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1(1):21–28

    Article  PubMed  CAS  Google Scholar 

  9. Enocson A, Hedbeck CJ, Tidermark J et al (2009) Dislocation of total hip replacement in patients with fractures of the femoral neck. A prospective cohort study of 713 consecutive hips. J Acta Orthop 80(2):184–189

    Article  Google Scholar 

  10. Folman Y, Ron Nimrod, Shabat Shay et al (2010) The Fixion expandable stem hemiarthroplasty for displaced femoral neck fracture: technical features and pilot study. Arch Orthop Trauma Surg 130:527–531

    Article  PubMed  Google Scholar 

  11. Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg 43:647–661

    Google Scholar 

  12. Gebhard JS, Amstutz HC, Zinar DM et al (1992) A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck. Clin Orthop Relat Res 282:123–131

    PubMed  Google Scholar 

  13. Gjertsen JE, Lie SA, Fevang JM et al (2007) Total hip replacement after femoral neck fractures in elderly patients: results of 8,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop 78(4):491–497

    Article  PubMed  Google Scholar 

  14. Goh SK, Samuel M, Su DH (2009) Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture. J Arthroplasty 24(3):400–406

    Article  PubMed  Google Scholar 

  15. Healy WL, Iorio R (2004) Total hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res 429:43–48

    Article  PubMed  Google Scholar 

  16. Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  Google Scholar 

  17. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from http://www.cochrane-handbook.org

  18. Kaltsas DS (2004) Infection after total hip arthroplasty. J Ann R Coll Surg Engl 86(4):267–271

    Article  Google Scholar 

  19. Karaeminogullari O, Demirors H, Atabek M et al (2004) Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery. Adv Ther 21(5):335–342

    Article  PubMed  Google Scholar 

  20. Keating JF, Grant A, Masson M et al (2005) Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technol Assess 9(41):1–65

    Google Scholar 

  21. Lee BP, Berry DJ, Harmsen WS et al (1998) Total hip arthroplasty for the treatment of an acute fracture of the femoral neck: long-term results. J Bone Joint Surg (Am) 80:70–75

    Article  CAS  Google Scholar 

  22. Lu-Yao GL, Keller RB, Littenberg B et al (1994) Outcomes after displaced fractures of the femoral neck: a meta-analysis of one hundred and six published reports. J Bone Joint Surg (Am) 76:15–25

    CAS  Google Scholar 

  23. Macaulay W, Pagnotto MR, Iorio R et al (2006) Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg 14:287–293

    PubMed  Google Scholar 

  24. Macaulay W, Nellans KW, Garvin KL et al (2008) 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 23(6 Suppl 1):2–8

    Article  PubMed  Google Scholar 

  25. Macaulay W, Nellans KW, Iorio R et al (2007) Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture. J HSS 4(1):48–54

    Article  Google Scholar 

  26. Masonis JL, Bourne RB (2002) Surgical approach, abductor function, and total hip arthroplasty dislocation. J Clin Orthop Relat Res 405:46

    Article  Google Scholar 

  27. Parker MJ, Gurusamy KS (2006) Internal fixation versus arthroplasty for intracapsular prox-imal femoral fractures in adults. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD001708. doi:10.1002/14651858.CD001708.pub2

  28. Patel PD, Potts A, Froimson MI (2007) The dislocating hip arthroplasty prevention and treatment. J Arthroplasty 22(4 Suppl 1):86–90

    Article  PubMed  Google Scholar 

  29. Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomised study. Injury 31(10):793–797

    Article  PubMed  CAS  Google Scholar 

  30. Iorio Richard (2008) Primary total hip replacement in patients with displaced femoral neck fractures. J Curr Opin Orthop 19(28–32):10

    Google Scholar 

  31. Rodríguez-Merchán EC (2002) Displaced intracapsular hip fractures: hemiarthroplasty or total arthroplasty? J Clin Orthop Relat Res 399:72–77

    Article  Google Scholar 

  32. Schmidt AH, Leighton R, Parvizi J et al (2009) Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma 23(6):428–433

    Article  PubMed  Google Scholar 

  33. Sen D, Alsousou J, Fraser J (2009) Painful hemiarthroplasty due to acetabular erosion: a new technique of treatment. J Bone Joint Surg Br 91(4):530–532

    Article  PubMed  CAS  Google Scholar 

  34. Sharkey PF, Rao R, Hozack WJ et al (1998) Conversion of hemiarthroplasty to total hip arthroplasty. J Arthroplasty 13:627–630

    Article  PubMed  CAS  Google Scholar 

  35. Sharrock NE, Gonzalez Della Valle A, Go G et al (2008) Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. J. Clin Orthop Relat Res 466(3):714–721

    Article  Google Scholar 

  36. Skinner P, Riley D, Ellery J et al (1989) Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. J Injury 20(5):291–293

    Article  CAS  Google Scholar 

  37. Squires B, Bannister G (1999) Displaced intravascular neck of femur fractures in mobile independent patients: total hip replacement or hemiarthroplasty. Injury 30:345–348

    Article  PubMed  CAS  Google Scholar 

  38. Suh KT, Moon KyuPill, Lee HongSeok et al (2009) Consideration of the femoral head cartilage thickness in preoperative planning in bipolar hemiarthroplasty. Arch Orthop Trauma Surg 129:1309–1315

    Article  PubMed  Google Scholar 

  39. Sutton AJ, Abrams KR, Jones DR et al (2000) Methods for meta-analysis in medical research. Wiley, Chichester

    Google Scholar 

  40. Tarasevicius S, Jermolajevas V, Tarasevicius R et al (2005) Total hip replacement for the treatment of femoral neck fractures. Long-term results. Medicina (Kaunas) 41:465

    Google Scholar 

  41. Victor Wilson, Huo et al (2004) Treatment of femoral neck fractures with prosthetic arthroplasty. J Curr Opin Orthop 15:18–21

    Article  Google Scholar 

  42. Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg (Am) 64:1295

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuang Yong Road, Nanning, 530021, Guangxi Province, China

    Liang Liao, Jin min Zhao, Wei Su, Xiao fei Ding, Liang jun Chen & Shi xing Luo

Authors
  1. Liang Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin min Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiao fei Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liang jun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shi xing Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin min Zhao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liao, L., Zhao, J.m., Su, W. et al. A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Arch Orthop Trauma Surg 132, 1021–1029 (2012). https://doi.org/10.1007/s00402-012-1485-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-012-1485-8

Keywords

Search

Navigation