Long-Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta-Analysis

Abstract

Objective: To compare the long-term efficacy of screw fixation and hemiarthroplasty in elderly patients with undisplaced femoral neck fractures.

Methods: We searched Cochrane Library, EMBASE, and MEDLINE from inception to 10 June 2020 to identify studies about undisplaced femoral neck fracture in elderly patients over 65 years of age. The included studies were assessed by two researchers according to the Cochrane risk-of-bias criteria and Newcastle-Ottawa Scale. Meta-analysis was performed with Revman 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables.

Results: A total of 750 patients were included in this meta-analysis. In elderly patients, undisplaced femoral neck fracture treated with hemiarthroplasty had a lower implant-related complication rate (OR, 4.05 [95% CI, 2.38 to 6.89]; P < 0.00001; I² = 0), lower reoperation rate (OR, 4.88 [95% CI, 2.84 to 8.38]; P < 0.00001; I² = 0), and superior Harris score (WMD, -5.05 [95% CI, -7.30 to -2.80]; P < 0.0001; I² = 0) in the early postoperative period. Although screw fixation was associated with shorter operative time (WMD, -36.22 [95% CI, -50.72 to -21.73]; P < 0.00001; I² = 98%) and less blood loss (WMD, -165.84 [95% CI, -209.29 to -122.38]; P < 0.00001; I² = 96%), there was no significant difference in long-term mortality (OR, 0.65 [95% CI, 0.28 to 1.48]; P < 0.31; I² = 75%) between these two treatments.

Conclusion: In elderly patients with undisplaced femoral neck fractures, hemiarthroplasty provided a lower implant-related complication rate, lower reoperation rate, superior hip function without increased long-term mortality. Hemiarthroplasty should be recommended as a better alternative in such patients compared with multiple cannulated screws.

Keywords: Elderly; Femoral neck fracture; Hemiarthroplasty; Screw fixation; Undisplaced.

Fig. 1

Flow diagram based on the PRISMA (Preferred Reporting Items for Systematic Meta‐Analyses) guidelines.

Fig. 2

Cochrane risk‐of‐bias criteria for randomized controlled trials.

Fig. 3

Comparison of the reoperation rate between screw fixation and hemiarthroplasty. Hemiarthroplasty had a significantly lower reoperation rate compared with screw fixation.

Fig. 4

Comparison of the mortality between screw fixation and hemiarthroplasty. There was no significant difference in mortality between the two treatments.

Fig. 5

Comparison of the complication rate between screw fixation and hemiarthroplasty. (A) implanted‐related complication rate, (B) total complication rate. Hemiarthroplasty had a significantly lower implanted‐related complication rate compared with screw fixation.

Fig. 6

Comparison of the Harris score between screw fixation and hemiarthroplasty. (A) 6‐months of Harris score, (B) 12‐months of Harris score, (C) 24‐months of Harris score. Hemiarthroplasty had significantly superior short‐term Harris score compared with screw fixation, but there was no significant difference in Harris score after 12 months postoperatively.

Fig. 7

Comparison of the Harris score between screw fixation and hemiarthroplasty. (A) blood loss, (B) hospital stay, (C) operation duration. Screw fixation had significantly superior blood loss, hospital stay, and operation duration compared with hemiarthroplasty.