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Meta-Analysis
. 2012 Aug;36(8):1549-60.
doi: 10.1007/s00264-012-1569-7. Epub 2012 May 24.

Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials

Paul T P W Burgers  1 , Arnoud R Van Geene, Michel P J Van den Bekerom, Esther M M Van Lieshout, Bastiaan Blom, Ilyas S Aleem, M Bhandari, Rudolf W Poolman
Affiliations
Meta-Analysis

Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials

Paul T P W Burgers et al. Int Orthop. 2012 Aug.

Abstract

Purpose: Displaced femoral neck fractures in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA). Recent data suggest that total hip arthroplasty (THA) may be a better alternative.

Methods: A systematic review of the English literature was conducted. Randomized controlled trials comparing all forms of THA with HA were included. Three authors independently extracted articles and predefined data. Results were pooled using a random effects model.

Results: Eight trials totalling 986 patients were retrieved. After THA 4 % underwent revision surgery versus 7 % after HA. The one-year mortality was equal in both groups: 13 % (THA) versus 15 % (HA). Dislocation rates were 9 % after THA versus 3 % after HA. Equal rates were found for major (25 % in THA versus 24 % in HA) and minor complications (13 % THA versus 14 % HA). The weighted mean of the Harris hip score was 81 points after THA versus 77 after HA. The subdomain pain of the HHS (weighted mean score after THA was 42 versus 39 points for HA), the rate of patients reporting mild to no pain (75 % after THA versus 56 % after HA) and the score of WOMAC (94 points for THA versus 78 for HA) all favored THA. Quality of life measured with the EQ-5D favored THA (0.69 versus 0.57).

Conclusions: Total hip arthroplasty for displaced femoral neck fractures in the fit elderly may lead to higher patient-based outcomes but has higher dislocation rates compared with hemiarthroplasty. Further high-quality randomized clinical trails are needed to provide robust evidence and to definitively answer this clinical question.

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Figures

Fig. 1
Fig. 1
Flow chart of article selection process
Fig. 2
Fig. 2
Revision surgery. Forest plot comparing risk ratios of revision and planned revision surgery after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Mantel-Haenszel statistical method was used with the ‘random effects’ analysis method for dichotomous data. M-H Mantel-Haenszel, THA total hip arthroplasty, HA hemiarthroplasty
Fig. 3
Fig. 3
One year mortality. Forest plot comparing risk ratios of one-year mortality after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Mantel-Haenszel statistical method was used with the ‘random effects’ analysis method for dichotomous data. M-H Mantel-Haenszel, THA total hip arthroplasty, HA hemiarthroplasty
Fig. 4
Fig. 4
Dislocation. Forest plot comparing risk ratios of dislocation after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Mantel-Haenszel statistical method was used with the ‘random effects’ analysis method for dichotomous data. M-H Mantel-Haenszel, THA total hip arthroplasty, HA hemiarthroplasty
Fig. 5
Fig. 5
Major complications. Forest plot comparing risk ratios of minor complications (as defined in Appendix 2) after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Mantel-Haenszel statistical method was used with the ‘random effects’ analysis method for dichotomous data. M-H Mantel-Haenszel, THA total hip arthroplasty, HA hemiarthroplasty
Fig. 6
Fig. 6
Minor complications. Forest plot comparing risk ratios of major complications (as defined in Appendix 2) after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Mantel-Haenszel statistical method was used with the ‘random effects’ analysis method for dichotomous data. M-H Mantel-Haenszel, THA total hip arthroplasty, HA hemiarthroplasty
Fig. 7
Fig. 7
Harris hip score. Forest plot comparing risk ratios of total Harris hip score after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Inverse variance statistical method was used with the ‘random effects’ analysis method for continuous data. IV inverse variance,THA total hip arthroplasty, HA hemiarthroplasty
Fig. 8
Fig. 8
Harris hip score subdomain pain. Forest plot comparing risk ratios of Harris hip score pain section after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Inverse variance statistical method was used with the ‘random effects’ analysis method for continuous data. IV inverse variance,THA total hip arthroplasty, HA hemiarthroplasty
Fig. 9
Fig. 9
No to mild pain. Forest plot comparing risk ratios of no-to-mild pain after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Mantel-Haenszel statistical method was used with the ‘random effects’ analysis method for dichotomous data. M-H Mantel-Haenszel, THA total hip arthroplasty, HA hemiarthroplasty
Fig. 10
Fig. 10
WOMAC subdomain pain. Forest plot comparing risk ratios of the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire (WOMAC) pain score after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Inverse variance statistical method was used with the ‘random effects’ analysis method for continuous data. IV inverse variance,THA total hip arthroplasty, HA hemiarthroplasty
Fig. 11
Fig. 11
Quality of Life EQ5D. Forest plot comparing risk ratios of quality of life derived from the EuroQol-5 Dimensions (EQ-5D) after total hip arthroplasty versus hemiarthroplasty in displaced femoral neck fractures in the healthy elderly. Inverse variance statistical method was used with the ‘random effects’ analysis method for continuous data. IV inverse variance,THA total hip arthroplasty, HA hemiarthroplasty
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