Comparison of arthroplasty vs. osteosynthesis for displaced femoral neck fractures: a meta-analysis

Feng-Jen Tseng,Jia-Fwu Shyu,Hsian-Chung Shen,Chih-Hung Wang,Wei-Tso Chia,Leou-Chyr Lin,Ching-Feng Weng,Ru-Yu Pan

doi:10.1186/s13018-017-0629-5

Feng-Jen Tseng, Jia-Fwu Shyu + Show 6 more

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https://doi.org/10.1186/s13018-017-0629-5

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Abstract

BackgroundThis meta-analysis compared clinical outcomes of arthroplasty vs. osteosynthesis for displaced femoral neck fractures.MethodsMeta-analysis was performed on the difference in revision rate and overall mortality between participants undergoing osteosynthesis vs. total hip arthroplasty (THA), osteosynthesis vs. hemiarthroplasty (HA), or THA vs. HA.ResultsPooled direct and indirect results indicated no significant difference in mortality between THA and HA (pooled OR = 0.87, 95% CI 0.55 to 1.38; P = 0.556), between THA and osteosynthesis (pooled OR = 1.17, 95% CI 0.69 to 1.99; P = 0.553), and between HA and osteosynthesis (pooled OR = 1.21, 95% CI 0.84 to 1.74; P = 0.304). Pooled direct and indirect results indicated no significant difference in revision rates between THA and HA (pooled OR = 0.90, 95% CI 0.26 to 3.19; P = 0.874). But, fewer revisions (OR = 0.19, 95% CI 0.10 to 0.34; P = 0.000) were seen in patients treated with THA than osteosynthesis and also in those treated with HA than osteosynthesis (OR = 0.12, 95% CI 0.07 to 0.20; P = 0.000). After excluding studies without showing normal cognition in inclusion criteria, pooled direct and indirect results also indicated no significant difference in mortality between THA, HA, and osteosynthesis. Similarly, there was no significant difference in revision rates between THA and HA, but HA and THA had significantly lower revision rates compared with osteosynthesis.ConclusionsThere was no significant difference in overall mortality among osteosynthesis, HA, and THA. However, HA and THA had significantly lower revision rates compared with osteosynthesis. Results of the present study provide support for the use of hip arthroplasty to treat displaced fractures of the femoral neck.

Highlights

This meta-analysis compared clinical outcomes of arthroplasty vs. osteosynthesis for displaced femoral neck fractures
HA was once considered the procedure of choice for elderly patients with displaced (Garden stage III or IV) femoral neck fractures [13], but a Swedish study concluded that total hip arthroplasty (THA) should be performed for displaced femoral neck fractures in older patients with normal mental function and high function [14], a conclusion that has been echoed in several more recent publications [15, 16]
All studies compared arthroplasty with osteosynthesis (Table 1); five studies compared THA (n = 218) with osteosynthesis (n = 235), 14 studies compared HA (n = 1518) with osteosynthesis (n = 1178), and only seven studies compared THA (n = 432) and HA (n = 462)

Summary

Introduction

This meta-analysis compared clinical outcomes of arthroplasty vs. osteosynthesis for displaced femoral neck fractures. Internal fixation is recommended for most non-displaced fractures of the femoral neck, the optimal treatment for displaced fractures of the femoral neck is still controversial [10,11,12]. HA was once considered the procedure of choice for elderly patients with displaced (Garden stage III or IV) femoral neck fractures [13], but a Swedish study concluded that THA should be performed for displaced femoral neck fractures in older patients with normal mental function and high function [14], a conclusion that has been echoed in several more recent publications [15, 16]. On the other hand, recommended either reduction with internal fixation or cemented HA as alternative treatments for a displaced intracapsular fracture in a mobile and mentally competent patient under 80 years of age [10]

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