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Meta-Analysis
. 2013 Jul 23;8(7):e68903.
doi: 10.1371/journal.pone.0068903. Print 2013.

Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis

Tao Li  1 , Qianyu Zhuang, Xisheng Weng, Lei Zhou, Yanyan Bian
Affiliations
Meta-Analysis

Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis

Tao Li et al. PLoS One. .

Abstract

Objective: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 70 years old.

Methods: We searched PUBMED, EMBASE, Cochrane Library, CNKI and VIP Database from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.

Results: 7 RCTs involving 1,125 patients (1,125 hips) were eligible for meta-analysis. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31-0.76; P = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29-0.64; P<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09-0.26; P<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37-9.49 min; P<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.

Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of searches.
Figure 2
Figure 2. Quality assessment of risk of bias in included studies.
“+”: low risk of bias, “?”: unclear risk of bias, “−”: high risk of bias.
Figure 3
Figure 3. Summary of quality assessment of risk of bias.
Figure 4
Figure 4. Forest plot of OR with confidence intervals for postoperative hip function.
Figure 5
Figure 5. Forest plot of OR with confidence intervals for residual pain.
Figure 6
Figure 6. Forest plot of OR with confidence intervals for sensitivity analysis of residual pain.
Figure 7
Figure 7. Forest plot of OR with confidence intervals for complications.
Figure 8
Figure 8. Forest plot of OR with confidence intervals for mortality.
Figure 9
Figure 9. Forest plot of OR with confidence intervals for reoperation rate.
Figure 10
Figure 10. Forest plot of WMD with confidence intervals for operation time.
Figure 11
Figure 11. Forest plot of WMD with confidence intervals for intraoperative blood loss.
Figure 12
Figure 12. Forest plot of WMD with confidence intervals for sensitivity analysis of intraoperative blood loss.
Figure 13
Figure 13. Summary of finding for the comparision and the quality of evidence.
See this image and copyright information in PMC

References

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