Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials

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.

Fig. 1

A flowchart shows the selection of studies for inclusion in the meta-analysis.

Fig. 2A–B

The funnel plots assess publication bias of the meta-analysis comparing THA with hemiarthroplasty for displaced intracapsular hip fractures for (A) reoperations (T_{Egger’s test} = −0.62; 95% CI, −1.41 to 2.45; P_{Egger’s test} = 0.55 > 0.05) and (B) mortality (T_{Egger’s test} = −0.60; 95% CI, −1.12 to 0.67; P_{Egger’s test} = 0.57 > 0.05). SE = standard error.

Fig. 3A–C

Meta-analysis results are shown for the comparison of THA with hemiarthroplasty for displaced intracapsular hip fractures regarding efficacy. The forest plot shows pooled RRs with 95% CIs suggesting (A) THA is associated with lower rate of reoperations (analysis of 10 studies; fixed-effects model) and (B) THA is not associated with lower rate of mortality (analysis of nine studies; fixed-effects model). (C) A forest plot shows pooled WMDs with 95% CIs suggesting THA is associated with better hip function (analysis of six individual studies; random-effects model). RR = risk ratio; WMD = weighted mean difference.

Fig. 4A–C

Meta-analysis results are shown for the comparison of THA with hemiarthroplasty for displaced intracapsular hip fractures regarding complications. The forest plots show pooled RRs with 95% CIs suggesting (A) THA is not associated with lower rate of local infections (analysis of eight studies; fixed-effects model), (B) THA is not associated with lower rate of general complications (analysis of nine studies; fixed-effects model), and (C) THA is associated with higher rate of dislocations (analysis of 11 studies; random-effects model). RR = risk ratio.