Hemiarthroplasty compared to total hip arthroplasty for the treatment of femoral neck fractures: a systematic review and meta-analysis

Xinbo Li,Jianning Luo

doi:10.1186/s13018-020-02186-4

Xinbo Li, Jianning Luo

Open Access

https://doi.org/10.1186/s13018-020-02186-4

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Abstract

BackgroundHip replacement is divided into total hip arthroplasty (THA) and hemiarthroplasty (HA); it is still controversial whether to choose THA or HA for femoral neck fractures (FNF). The goal of this study was to review relevant studies in order to determine the HA compared to THA for the treatment of FNF.Patients and methodsUsing appropriate keywords, we identified relevant studies using PubMed, Cochrane, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through August 2019 were considered for inclusion. For each study, we assessed odds ratios (ORs), mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes.ResultsWe included 19 studies with a total of 413,140 patients in the HA group and 44973 in the THA group. The blood loss, surgery time, and dislocation were all significantly decreased in the HA group than the THA group. The length of hospital, pneumonia, and renal failure were significant increased in the HA group than THA group. There has no significant difference of complication, mortality, reoperation, infection, pulmonary embolism, and myocardial infarct between the two groups.ConclusionHA has favor in decrease blood loss and surgery time. THA has favor in decrease the length of hospital, the incidence of pneumonia and renal failure. For the selection of surgical methods for femoral neck fracture in the elderly, we should consider several aspects, such as the age of the patient, whether there is osteoporosis, the type of femoral neck fracture, the preoperative reduction situation, and the needs of the patient and his family for the postoperative situation.

Highlights

femoral neck fractures (FNF) accounts for about 3.6% of adult fractures, which is one of the more common fractures in the body
Search strategy To identify studies pertaining to the clinical results about HA versus total hip arthroplasty (THA) in the treatment of FNF, we reviewed the Cochrane, Pubmed, Embase databases for relevant articles published through August 2019
The incidence of pneumonia (RR, 1.511; 95% 95% confidence interval (CI), 1.275 ~ 1.791) and renal failure (RR, 1.493; 95% confidence interval (95% CI), 1.188 ~ 1.876) were significantly higher in the HA group than the THA group

Summary

Introduction

FNF accounts for about 3.6% of adult fractures, which is one of the more common fractures in the body. FNF is more common in elderly patients, generally refers to the fracture in the part of the femoral head down to the base of the femoral neck. FNF in older patients are not stable fractures (Garden III, IV), accompanied with the complications: the serious situation of displacement fracture, the longer time of conservative treatment in bed, pulmonary embolism, falling pneumonia, lower limb thrombosis, bone nonunion, urinary system infection, and so on. The conservative treatment of fracture carries the bad counterpoint to the line, high rate of fracture malunion, physical disability, ischemic necrosis of femoral head; so still need hip replacement later. Hip replacement is divided into total hip arthroplasty (THA) and hemiarthroplasty (HA); it is still controversial whether to choose THA or HA for femoral neck fractures (FNF).

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